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Date run 12/26/2014 1:29:43F SAN . .41,W COUNTY ENVIRONMENTAL HEAL ET'ARTMENT Report #5021 <br />Pagel <br />Run by <br />Facility Information as of 1212fi12D1 <br />Record Selection Criteria: Facility ID FA0010223 <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 <br />owner ID <br />OW0008223 Case Number: H07381 <br />owner Name <br />JANOFSKY, JON <br />Owner DBA <br />RMB GARAGE <br />Owner Address <br />715 N HUNTER ST <br />209-464-44&1--X— <br />09 "37-^e& YMailing <br />STOCKTON, CA 952021704 <br />Home Phone <br />W9-ZS,5-32_1-0--'�`r`7 <br />Work/Business Phone <br />209-467-443-t" <br />Mailing Address <br />715 N HUNTER ST #A <br />i <br />Ay,C.(_•��t:'I/�t �•Q / �� <br />'Pe <br />STOCKTON, CA 95202-1704 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID I CERS ID <br />FA0010223 10183339 <br />Facility Name <br />RMB-"GA-RA`GLE- <br />Location <br />715 N HUNTER ST <br />EMail: <br />STOCKTON, CA 95202-1720 <br />Phone <br />209-464-44&1--X— <br />09 "37-^e& YMailing <br />MailingAddress <br />71'5 N HUNTER ST #A <br />STOCKTON. CA 95202-1704 <br />Care of <br />Alice Gonzales <br />Location Code <br />i <br />Ay,C.(_•��t:'I/�t �•Q / �� <br />'Pe <br />BOS District <br />APN 13905409 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0017223 <br />Mail Invoices to Owner <br />Account Name JANOFSKY,JON <br />Account Balance as of 1 2/2612 0 1 4: $0.00 <br />r JAS <br />cl f� <br />Program/Element and Description �tJ Record ID <br />X1920 - HMBP-Common Materials PRO520157 <br />(2220 - SM HW GEN <5 TONSIYR PR0514237 <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512511 <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510223 <br />ERSC- ELECTRONIC REPORTING STATE SURCHARG PR0533694 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) r 1� <br />OWNERSHIP CHANGE (date) V { <br />SSNI Fed Tax ID <br />New Ow . r D <br />1e 16 VVI Li', � <br />t <br />02 04 CIA 6, <br />II <br />/ s <br />r <br />Alt Phone <br />Fax <br />EMail: <br />/] <br />New Account ID: <br />Maillnvoic to: Owner 1 <br />J� <br />Facility I Account <br />(Circle One) <br />i <br />Ay,C.(_•��t:'I/�t �•Q / �� <br />'Pe <br />I lfl <br />/ <br />1, � <br />� (Circle One) <br />{!J , i/�!J <br />Transfer to Activellnactve <br />Employee ID and Name <br />EE0009817 - ROBERT LOPEZ <br />Status <br />l/ ZeActive <br />New Owner? Delete <br />Y N A D <br />EE0009488 - JEFFREY WONG <br />11 (UJ Active <br />Y N A 1� D <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y N A I D <br />EEO000000 - HAZ MAT SJC OES <br />InactivE <br />Y N A I D <br />Inactive <br />Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all silo, and/or project specific, PHSIEHD 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 applicableG- Ordinance Codes andlor Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: Date 1 I <br />Program Records to be TRANSFERED: * $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />RFHS- <br />COMMENTS: <br />Amount Paid Date 1 1 <br />Received by <br />Date 1 1 Account out: _ L/6— Date ?J <br />