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Date run 2/16/2010 8:26:16AN SAN JUIN COUNTY ENVIRONMENTAL HE/ `i DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/16/2010 <br /> Record Selection Criteria: Facility ID FA0009949 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0007949 Case Number: H05980 New Owner ID <br /> Owner Name GAMEZ, ALDO <br /> Owner DBA PRO-TOUCH AUTO REPAIR <br /> Owner Address 728 BISHOP ST <br /> MANTECA, CA 95337 <br /> Home Phone 209-824-8182 <br /> Work/Business Phone 209-239-9250 <br /> Mailing Address 728 BISHOP ST <br /> MANTECA, CA 95337 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009949 <br /> Facility Name PRO-TOUCH AUTO REPAIR <br /> Location 255 MOFFAT BLVD <br /> MANTECA, CA 953365742 <br /> Phone 209-239-9250 <br /> Mailing Address 255 MOFFAT BLVD <br /> MANTECA, CA 953365742 <br /> Care of ALDO JOEL & DONNA GAMEZ <br /> Location Code 04- MANTECA Alt Phone <br /> BOS District 005 - ORNELLAS, LEROY Fax <br /> APN 22106021 EMail : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ALDO JOEL & DONNA GAMEZ <br /> Title <br /> Day Phone 209-239-9250 <br /> Night Phone 209-824-8182 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016949 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name PRO-TOUCH AUTO REPAIR (Circle One) <br /> Account Balance as of 2/16/2010: $362.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514107 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512237 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0519981 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO509949 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0533887 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <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 Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />