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Date win 2/11/2014 4:01:38Ph SAN JCWUIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by 1273 Pagel <br /> Facility Information as of 2/11/2014 <br /> Record Selection Criteria: Facility ID FA0019100 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0018137 New Owner ID <br /> Owner Name LITHIA OF STOCKTON <br /> Owner DBA NISSAN KIA OF STOCKTON <br /> Owner Address 3077 E HAMMER LN <br /> STOCKTON, CA 95212— q`av <br /> Home Phone 209-956-6500 <br /> Work/Business Phone Not Specified 1 <br /> Mailing Address PO BOX 691180 3,9-? -7 El t'r?vt1ls l! 'I L FJ <br /> STOCKTON, CA 96269 1 180 <br /> Care of q�a►a-o2�'o r <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0019100 10,187,055 <br /> Facility Name NISSAN KIA OF STOCKTON <br /> Location 3077 E HAMMER LN <br /> STOCKTON, CA 95212 <br /> Phone 209-956-6500 �'I. <br /> Mailing Address PO BOX 691180 L 7 7191*, ni E:R <br /> STOCKTON, CA a€369Y180— <br /> Care of I 1 It <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 003- BESTOLARIDES Fax <br /> APN 12618019 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name RON AGUTAR <br /> Title SERVICE MGR <br /> Day Phone 209-956-6500 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034013 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name NISSAN KIA OF STOCKTON (circle one) <br /> Account Balance as of 2/11/2014: $2,067.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> PrograMElemenl and Description Record ID Employee ID and Name Status New Omen Delete <br /> 1921 -HMBP-Regular-Primary Location PRO528772 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PRO528320 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0528319 EE0004636-GARRETT BACKUS Active,l Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0528247 EE0002620-ALFONSO ARAMBULA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533074 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and'or project specific,PHSIEHO hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andfor Standards and State andlor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Race' y <br /> REHS: Date / / Account <br /> ouppt: rr,, Date <br /> COMMENT ' \�,Qi •H{.�[�f `�/�N/��_� ���E�L y/x/�J �„V�l�. <br />