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Date run 12/21/2017 10:04:54/ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 Run by Pagel ' Facility Information as of 12/21/2017 Record Selection Criteria: Facility ID FA0019818 OWNER FILE INFORMATION Number of facilities for this owner Owner ID OW0016260 Owner Name RAMIREZ, JOSE Owner DBA BROTHERS AUTO BODY & REPAIR Owner Address 1130 E MAIN ST APN STOCKTON, CA 95205 Home Phone 408-595-2201 Work/Business Phone 209-941-2944 Mailing Address 1130 E MAIN ST STOCKTON, CA 95205 Care of FACILITY FILE INFORMATION Facility lD/CERS ID FA0019818 10614778 FacilityName BROTHERS AUTO BODY & REPAIR Location 1130 E MAIN ST STOCKTON, CA 95205 Phone 209-941-2944 Mailing Address 1130E MAIN ST Make changeslcorrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN/Fed Tax ID New Owner ID : EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name JOSE RAMIREZ Title Day Phone 209-941-2944 Night Phone 408-595-2201 (7� ACCOUNTS RECEIVABLE FILE INFORMATION I 0 Account ID AR0035278�tEPAIR !� fl � New Account ID: Mail Invoices to Facility 11-,>W„\ nvoices to: Owner / Facility / Account Account Name BROTHERS AUTO BODY & hN)Y (Circle One) Account Balance as of 12/21/2017: $2, 0 w�i UL �l g �S• (Circle One) Transfer to Aclivellnactve Program/Element and Description Record ID Employee ID and Name Status New Owner? �ae 2220 - SM HW GEN <5 TONS/YR PR0539491 EE9999996 - THREE VACANT3 Active Y N A 4740 - WASTE TIRE SITE - EXEMPT PR0530231 EE0002622 - BENJAMIN ESCOTTO Inactive Y N A BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andor project specific, PHS•EHD hourly charges associated with this facility or activity will be billed to the party identified as the OWNER on this form Ialso certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and StateancVor Federal Laws. APPLICANTS SIGNATURE: Date Program Records to be TRANSFERED: ` $25.00 = Amount Paid Date // Water System to be TRANSFERED: Amount Paid Date // Payment Type Check Number Received b EHD Staff: Date /Z / Account out: Date �" /� COMMENTS: Invoice #: 6, STOCKTON, CA 95205 Careof JOSE RAMIREZ Location Code 01 -STOCKTON BOB District 001 - VILLAPUDUA, CARLOS APN 15120404 Make changeslcorrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN/Fed Tax ID New Owner ID : EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name JOSE RAMIREZ Title Day Phone 209-941-2944 Night Phone 408-595-2201 (7� ACCOUNTS RECEIVABLE FILE INFORMATION I 0 Account ID AR0035278�tEPAIR !� fl � New Account ID: Mail Invoices to Facility 11-,>W„\ nvoices to: Owner / Facility / Account Account Name BROTHERS AUTO BODY & hN)Y (Circle One) Account Balance as of 12/21/2017: $2, 0 w�i UL �l g �S• (Circle One) Transfer to Aclivellnactve Program/Element and Description Record ID Employee ID and Name Status New Owner? �ae 2220 - SM HW GEN <5 TONS/YR PR0539491 EE9999996 - THREE VACANT3 Active Y N A 4740 - WASTE TIRE SITE - EXEMPT PR0530231 EE0002622 - BENJAMIN ESCOTTO Inactive Y N A BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andor project specific, PHS•EHD hourly charges associated with this facility or activity will be billed to the party identified as the OWNER on this form Ialso certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and StateancVor Federal Laws. APPLICANTS SIGNATURE: Date Program Records to be TRANSFERED: ` $25.00 = Amount Paid Date // Water System to be TRANSFERED: Amount Paid Date // Payment Type Check Number Received b EHD Staff: Date /Z / Account out: Date �" /� COMMENTS: Invoice #: 6,