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sell <br /> F <br /> un 1/8/2010 11:26:57AM SAN JI <br /> JIN COUNTY ENVIRONMENTAL IiEAI DEPARTMENT Report#5021 <br /> 1.rr <br /> Facility Information as of 1/8/2010 Paget <br /> Record Selection Cmeda: Facility ID FA0014331 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> Owner ID <br /> OW0011382 Case Number: H03965 New Owner ID <br /> Owner Name TIRES PLUS <br /> Owner DBA WHEEL WORKS <br /> Owner Address 802 S FIRST ST <br /> SAN JOSE, CA 95110 <br /> Home Phone Not Specified <br /> Work/Business Phone 800-269-4424 <br /> Mailing Address 802 S FIRST ST <br /> SAN JOSE, CA 95110 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014331 <br /> Facility Name WHEEL WORKS <br /> Location 420 W LODI AVE <br /> LODI, CA 95240 <br /> Phone 209-339-9500 <br /> Mailing Address 802 S FIRST ST <br /> SAN JOSE, CA 95110 <br /> Care of <br /> Location Code 02- LODI Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 04502047 Ell <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION , <br /> Contact Name \ <br /> Title 7 �� <br /> Day Phone 209-339-9500 <br /> Night Phone - <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024355 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name TIRES PLUS (CirdeOn.) <br /> Account Balance as of 1/8/2010: $0.00 <br /> (Circle One) <br /> ProgrameElement and DescriptionTransfer to Activellnactve <br /> Record ID Employee ID and Name Status <br /> New Owner! Delete <br /> 220 SM HW GEN<5 TONS/YR PRO523179 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0521212 EEOOOOOOo-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0519163 EEOOOOo00-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0522552 EE5555555-Garrett Alias-Backus Active Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project spec,PHSIEHD hourly charges associated with this <br /> f�c'lily or activity will be billed to the party,identified as me OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordmace Codes and/or Standards and <br /> le aodlorbFederal Laws. 9 .11 4,161 A, <br /> Ck,Atiko v <br /> APPLICA" SIGNATURE: Data / I <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date / <br /> Payment Type Check Number Racalv d <br /> REHS: IKL rML Date It Account out: Data_/�1Q <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />