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Date run 3/8/2013 9:47:33AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report x5021 <br />Run by Pagel <br />Facility Information as of 3/8/2013 <br />Record Selection Criteria: Facility ID FA0009861 <br />OWNER FILE INFORMATION <br />Owner ID OW0007861 Case Number: H05670 <br />Owner Name NAVARRO, ARMANDO$aikdfi9@3frrt <br />Owner DBA NAVARRO BUSINESS ENT LLC <br />Owner Address-3t08-8jtyjq +T -DR <br />STOCKTON, CA "`62+2 -- <br />Home Phone Not Specified <br />Work/Business Phone 209-951-9912 <br />Mailing Address `3�p <br />STOCKTON, CA-1,T±+2-- <br />Care <br />A ,Care of <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0009861 <br />Facility Name <br />CHANGE OIL NOW! <br />Location <br />720 E HAMMER LN5TEIS2, <br />I D <br />STOCKTON, CA 95210 <br />Phone <br />209-951-9912 <br />Mailing Address <br />720 E HAMMER LN 5TH_ <br />A <br />STOCKTON, CA 95210 <br />Care of <br />NAVARRO BUSINESS ENT LLC <br />Location Code <br />01-STOCKTON <br />BOS District <br />002 - RUHSTALLER, LARRY <br />APN <br />09402043 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0016861 <br />Maillnvoicesto Facility <br />Account Name CH 3: 394 0 ! <br />Account Balance as of 3/8/2013: 1,394.0 <br />Program/Element and Description <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN /Fed Tax ID <br />New Owner ID : <br />RcNhe�\ NrxVG�(<0 <br />�lv..rr.lr< yC Ca'rL <br />�Y �S4�fNNDO XAtAWYO <br />\) Ch 'ti <br />Alt Phone <br />Fax <br />EMail : <br />��4 `vStalWt (0 <br />OWtiYG t}� <br />Mail Invoices to: <br />vollFFA %\&14 <br />Record ID Emp a ID and Name <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Activdlnache <br />Status New Owner' Delete <br />1920 - HMBP-Common Materials PR0519922 <br />EE0006044 - LOWELL ALLEN <br />Active <br />Y <br />N <br />A <br />I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOtPRO512149 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A <br />I D <br />2228 - GEN 25<50 TONS PERMIT PRO514066 <br />EE0004636 - GARRETT BACKUS <br />Active <br />Y <br />N <br />A <br />I D <br />2332- EXEMPT TANK FACILITY PRO528853 <br />EE0004636 - GARRETT BACKUS <br />Active,Exempt <br />Y <br />N <br />A <br />I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHAR(PR0509861 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A <br />I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHPR0532603 <br />Inactive <br />Y <br />N <br />A <br />I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and'or project <br />speck, PHS/EHD hourly charges associated with this <br />facility <br />or activity will be billed to the party idenlified as the OWNER on this form I also certify that <br />all operations will be performed in accordance with all applicable Ordinance Codes andor Standards <br />and State <br />andor <br />Federal Laws, <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: _ <br />Payment Type <br />REHS: <br />COMMENTS: <br />Check Number <br />' $25.00 = <br />Amount Paid _ <br />Amount Paid <br />Date <br />Date <br />- Date <br />Received by <br />Date //_ Account out: Date <br />