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E10ate 1/10/2013 8:39:18AN SAN JOIN COUNTY ENVIRONMENTAL HEAI" DEPARTMENT Report#5021 <br /> Facility Information as of 1/10/20* Pagel <br /> lection Criteria: Facility ID FA0014701 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011712 New Owner ID <br /> Owner Name HENRY HERNANDEZ <br /> Owner DBA FLEET CARE <br /> Owner Address 2915 MUNFORD AVE <br /> STOCKTON, CA 952058019 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-462-6254 <br /> Mailing Address 2915 MUNFORD AVE <br /> STOCKTON, CA 952058019 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014701 <br /> Facility Name FLEET CARE <br /> Location 2915 MUNFORD AVE <br /> STOCKTON, CA 952058019 <br /> Phone 209-462-6254 x0 <br /> Mailing Address 2915 MUNFORD AVE <br /> STOCKTON, CA 952058019 <br /> Care of <br /> Location Code Alt Phone <br /> BOIS District Fax <br /> APN 17910041 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025008 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name HENRY HERNANDEZ (Circle One) <br /> Account Balance as of 1/10/2013: $0.00 <br /> (Circle One) <br /> Transfer to Activerinacive <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0521627 EE0002474-MICHAEL PARISSI Active Y N A 0 D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPRO532567 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,admowledge that all site,andor protect specific,PHS/EHD 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 perfumed in accordance with all applicable Ordinance Codes anclor Standards and State andior <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment t^? � Check Number Recei y <br /> REHS: \Qr Date 111 Account out: Date (V <br /> COMMENTS: <br />