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Date run 9/4/2014 4:11:47PM SAN JOIN COUNTY ENVIRONMENTAL HEALI&EPARTMENT Report #5021 <br />Run by Pagel <br />Facility Information as of 9/4/2014 <br />Record Selection Criteria: Facility ID FA0019818 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0016260 <br />Owner Name <br />RAMIREZ, JOSE <br />Owner DBA <br />BROTHERS AUTO BODY & REPAIR <br />Owner Address <br />1130 E MAIN ST <br />Phone <br />STOCKTON, CA 95205 <br />Home Phone <br />408-595-2201 <br />Work/Business Phone <br />209-941-2944 <br />Mailing Address <br />1130 E MAIN ST <br />Location Code <br />STOCKTON, CA 95205 <br />Care of <br />001 - VILLAPUDUA <br />FACILITY FILE INFORMATION <br />Facility lD/CERS ID <br />FA0019818 <br />Facility Name <br />BROTHERS AUTO BODY & REPAIR <br />Location <br />1130 E MAIN ST <br />STOCKTON, CA 95205 <br />Phone <br />209-941-2944 <br />Mailing Address <br />1130 E MAIN ST <br />STOCKTON, CA 95205 <br />Care of <br />JOSE RAMIREZ <br />Location Code <br />01-STOCKTON <br />BOS District <br />001 - VILLAPUDUA <br />APN <br />15120404 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name JOSE RAMIREZ <br />Title <br />Day Phone 209-941-2944 <br />Night Phone 408-595-2201 <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0035278 <br />New Account ID: <br />: <br />Mail Invoices to Facility <br />Mail Invoices to: Owner / <br />Facility / Account <br />Account Name BROTHERS AUTO BODY <br />(Circle One) <br />Account Balance as of 9/4/2014: $0.00 <br />�%�s <br />I <br />2.E!7) <br />Tr r��L/n <br />/ 1 0 4 <br />(Circle One) <br />Transfer to AdlveMacNe <br />Program/Element and Description <br />Status <br />New Owner? Delete <br />4740 - WASTE TIRE SITE - EXEMPT <br />PRO530231 <br />EE0002622 <br />- BENJAMIN ESCOTTO Active <br />Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, anclor project specific, PHSIEHD hourly charges associated YAM 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 applicable Ordinance Codes andfor Standards and State and'or <br />Federal Laws. <br />APPLICANTS SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Type Check Number Recei e <br />REHS: Date / I ccount out: Date <br />COMMENTS: ��� <br />��� L ( 0 V aC r is ti� � <br />C}� L nada-3�3 �ksQ.e�y-n / <br />