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Daterun 4/9/2015 4:20:22PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Run by Repoli%5021 <br /> Facility Information as of 4/9/2015 Pagel <br /> Record Selection Criteria: Faulity 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 <br /> SSN/Fed Tax ID <br /> Owner ID OW0014725 New Owner ID : <br /> Owner Name SPEEDCO INC <br /> Owner DBA SPEEDCO <br /> Owner Address 703 W PARK ST <br /> CAYUGA. IN 47928 <br /> Home Phone Not Specified <br /> Work/Business Phone 765-492-5268 <br /> Mailing Address .pQ go X 52E) OV1- a 11K <br /> IN 17928.(`OVI G17928. ( 0 Y r IL&III OE <br /> Care of Tl 37 0 <br /> VID <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017929 10186697 <br /> Facility Name SPEEDCO <br /> Location 1515 HOFF DR <br /> RIPON, CA 95366 <br /> Phone 209-599-7961 x <br /> Mailing Address p4a-.Be%-5" O <br /> GFYI GA,Nl -A+-9 o <br /> Care of Speedco, Inc <br /> Location Code 05 - RIPON FFax <br /> BOB District 005 - ELLIOTT, BOBAPN 24534026 <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0031458 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SPEEDCO (ClraeOne) <br /> Account Balance as of 4/9/2015: $0.00 <br /> (Circe One) <br /> Transfer to Active/Inadve <br /> Program/Element and Description Recoml ID Employee ID and Name Status New Omer? Delete <br /> ,-1921 -HMBP-Regular-Primary Location PRO526534 EE0002474-MICHAEL PARISSI —Active Y N A I D <br /> /2220-SM HW GEN<5 TONSNR PRO538579 EE0009001 -ELENA MANZO --Active Y N A I D <br /> i 2832-AST FAC 10 K-</=100 K GAL CUMULATIVE PR0528646 EE0009001 -ELENA MANZO -Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO526488 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531876 Inactivf Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project specific.PHSrEHD hourly Merges assn atetl with this faolity <br /> or eotivay will be billed to the pony identified es the OWNER on this form. I also candy that all operations will be performed in accordance with all applicable Ordinance Codes anclor Standards and State ardor <br /> Federal Lava. a"{' <br /> APPLICANTS SIGNATURE: L Date / l l A� <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date / I <br /> Water System to be TRANSFERED: Amount Paid Date I / <br /> Payment Type Check Number Received y <br /> REHS: Date_/ / Account out: Date / T/LE <br /> COMMENTS: <br />