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Date run 7/6/2018 3:42:27PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/6/2018 <br /> Record Selection Criteria: Facility ID FA0017929 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0014725 New Owner ID <br /> Owner Name Speedco Inc#944 <br /> Owner DBA SPEEDCO <br /> OwnerAddress PO BOX 26210 <br /> OKLAHOMA CITY, OK 73126 <br /> Home Phone Not Specified <br /> Work/Business Phone 405-687-1060 <br /> Mailing Address P.O. BOX 26210 <br /> Oklahoma City, OK 73126 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017929 10186697 <br /> Facility Name SPEEDCO#944 <br /> Location 1515 HOFF DR <br /> RIPON, CA 95366 <br /> Phone 209-599-7691 x <br /> Mailing Address PO BOX 26210 <br /> OKLAHOMA CITY, OK 73126 <br /> Care of Speedco, Inc#944 <br /> Location Code 05 - RIPON Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 24534026 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JESSE DIAZ <br /> Title ENVIRONMENTAL MANAGER <br /> Day Phone 405-687-1060 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0031458 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SPEEDCO#944 (Circle One) <br /> Account Balance as of 7/6/2018: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0526534 EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> 2220-SM HW GEN <5 TONS/YR PR0538579 EE0000031 -ELIANNA FLORIDO Active Y N A I D <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVE PRO528646 EE0000031 -ELIANNA FLORIDO Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0526488 EE0004486-ANGELICA SANDOVAL MARII Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO531876 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,PHS/EHD 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 and/or Standards and State and(or <br /> Federal Laws. <br /> APPLICANT'S 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 Received by <br /> EHD Staff: Date / Account out: Date <br /> COMMENTS: �I e—/,(' / ('y\Qh / e— ? Invoice#: <br /> f'v a �3 � <br />