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Date run 1/21/2010 8:51:16AN SAN�TJIN COUNTY ENVIRONMENTAL HF�-t DEPARTMENT Report #5021 <br />Pa <br />Run by Facility Information as of 1/21/20lu gel <br />Record Selection Criteria: Facility ID FA0006943 <br />WOWNER FILE INFORMATION <br />Owner ID <br />OW0005703 <br />Owner Name <br />FAQUIRYAN, SHAMSUDDIN <br />Owner DBA <br />Mail Invoices to: Owner / <br />Owner Address <br />5248 WINDING WAY <br />Onµ6 <br />VACAVILLE, CA 95688 <br />Home Phone <br />707-592-9137 <br />Work/Business Phone <br />209-982-5779 <br />Mailing Address <br />5248 WINDING WAY <br />Employee ID and Name <br />VACAVILLE, CA 95688 <br />Care of <br />FAQUIRYAN, SHAMSUDDIN <br />FACILITY FILE INFORMATION <br />Co gt'YJ6 <br />Facility ID <br />FA0006943 <br />Facility Name <br />LATHROP CHEVRON <br />Location <br />140 E LATHROP RD <br />lcAA)uAAL) <br />LATHROP, CA 95330 <br />Phone <br />209-982-5779 <br />Mailing Address 140 E LATHROP RD <br />LATHROP, CA 95330 <br />Care of FAQIRYAN, SHAMSUDDIN <br />Location Code 07 - LATHROP <br />BOS District 003 - BESTOLARIDES <br />APN 19611007 <br />AMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name SHAMSUDDIN FAQIRYAN <br />Title <br />Day Phone 209-982-5779 <br />Night Phone 707-592-9137 <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0009855 <br />Mail Invoices to Facility <br />Account Name LATHROP CHEVRON <br />�Account Balance as of 1/21/2010: $0.00 <br />/y <br />R� l/foR Record ID <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID : - <br />New Owner ID O tJ r /% <br />11uT 7QFc. &A(: SNL <br />I`;OIC. <br />MO;VTF V)S1A _ <br />VA(4v)LL2 <br />CA q,�7,V,R <br />4o-�' -4-4P-3666 <br />Mail Invoices to: Owner / <br />Facility / <br />Account <br />Onµ6 <br />A I D <br />(Circle one) <br />Inactive <br />Y <br />N <br />Transfer to <br />(Circle One) <br />Active/Inadve <br />Employee ID and Name <br />06 <br />-rw'yaw <br />lq0 GA7PtQf` <br />Rd) <br />l.A7�1R,DF <br />Co gt'YJ6 <br />ficrt -948- 30ov <br />C M6 <br />EE0005642 - MICHELLE HENRY <br />Active <br />Y <br />/0AxaA79i <br />lcAA)uAAL) <br />Alt Phone <br />Y <br />Fax <br />A I D <br />EMail : <br />Inactive <br />A)4M 147H kAAn 1 J fhb) <br />EKES[ DE Nf <br />�y7. 49'7+a <br />t <br />—90z- SJY; <br />` W 0 - RETAIL MARKET < 1000 SQ FT W / FOOD PPRO506097 <br />2220 - SM HW GEN <5 TONS/YR PRO518581 <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512906 <br />2244 -PACT TRANSFER RECORD - DES PRO520435 <br />2301- UST STATE SURCHARGE FEE PRO515563 <br />///'''2361 -UST FACILITY PRO505687 <br />/ 2399 - UNIFIED PROGRAM FAC STATE SURCHARPRO507640 <br />( 2399 - UNIFIED PROGRAM FAC STATE SURCHARPRO518583 <br />r 5aa�3 <br />EE0001699 - JOHNNY YOAKUM <br />New Account ID: <br />: <br />N <br />A I D <br />Mail Invoices to: Owner / <br />Facility / <br />Account <br />N <br />A I D <br />(Circle one) <br />Inactive <br />Y <br />N <br />Transfer to <br />(Circle One) <br />Active/Inadve <br />Employee ID and Name <br />Status <br />New Omer? <br />Delete <br />` W 0 - RETAIL MARKET < 1000 SQ FT W / FOOD PPRO506097 <br />2220 - SM HW GEN <5 TONS/YR PRO518581 <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512906 <br />2244 -PACT TRANSFER RECORD - DES PRO520435 <br />2301- UST STATE SURCHARGE FEE PRO515563 <br />///'''2361 -UST FACILITY PRO505687 <br />/ 2399 - UNIFIED PROGRAM FAC STATE SURCHARPRO507640 <br />( 2399 - UNIFIED PROGRAM FAC STATE SURCHARPRO518583 <br />r 5aa�3 <br />EE0001699 - JOHNNY YOAKUM <br />- Active <br />Y <br />N <br />A I D <br />EE0005642 - MICHELLE HENRY <br />Active <br />Y <br />N <br />A I D <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A 1 D <br />EE0000000 - HAZ MAT SJC DES <br />Active <br />Y <br />N <br />A I D <br />EE0007289- ALISON YOUNGBLOODInactive <br />Y <br />N <br />A 1 D <br />EE0005642 - MICHELLE HENRY <br />Active <br />Y <br />N <br />A I D <br />EE0007289- ALISON YOUNGBLOOD Inactive <br />Y <br />N <br />A I D <br />EE0001422 - ARIS CACAPIT <br />Inactive <br />Y <br />N <br />A I D <br />C691�16 f9 exPlIk ?ttl /G (8 <br /><f "a I � I / to �v / 9011 <br />d <br />\\eh-env\envision\reports\5021.rot <br />PAYMENT <br />RECEIVED <br />FEB 10 2010 <br />SAN JOAQUIN COUNTY <br />NT <br />HEALTH DEPARTTMENT <br />(0 -If aDIISS <br />