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5/19/2008 2:41:18PN SAN JOOOUIN COUNTY ENVIRONMENTAL HEH DEPARTMENT Report#5021 <br /> Ru' A06 ! Pagel <br /> Facility Information as of 6/19/2 <br /> Record Selection Criteria: Facility ID FA0018844 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0005914 New Owner ID <br /> Owner Name RODGERS, DON <br /> Owner DBA DON RODGERS <br /> Owner Address 515 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 515 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Care of DON RODGERS <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018844 <br /> Facility Name TRANSMISSION SHOP <br /> Location 515 CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone <br /> Mailing Address 515 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -GUTIERREZ, STEVE Fax <br /> APN 14707408 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 AR0033493 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SHAW ENVIRONMENTAL (Circle One) <br /> Account Balance as of 6/19/2008: $490.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB SITE PR0527799 EE0006219-LORI DUNCAN 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. \ n <br /> APPLICANT'S SIGNATURE: /mac f-T r C- �� Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANySFERED: $372.00= Amount Paid "tste 1 <br /> Payment Type ,/ Check Number tF r'o �-[ �- Received by <br /> REHS: Date / / Account out: Date / ! <br /> COMMENTS: <br /> X39 <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />