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tin 1/5/2012 8:65:46AM SAN JO! " AN COUNTY ENVIRONMENTAL HEAI —'!'DEPARTMENT Report#5021 <br /> .<un byPagel <br /> ,i''0' Facility Information as Of 115120 <br /> Record Selection Criteria: Facility ID FA0007717 <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 OW0006374 New Owner ID <br /> Owner Name THRIFTY OIL COMPANY <br /> Owner DBA THRIFTY OIL#171 <br /> Owner Address 13539 E FOSTER <br /> SANTE FE SPRINGS, CA 90670 <br /> Home Phone 562-921-3581 <br /> Work/Business Phone Not Specified <br /> Mailing Address 13539 E FOSTER <br /> SANTE FE SPRINGS, CA 90670 <br /> Care of CHRIS PANIATESCU <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0007717 <br /> Facility Name THRIFTY OIL#171 <br /> Location 1250 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Phone <br /> Mailing Address 13539 E FOSTER <br /> SANTE FE SPRINGS, CA 90670 <br /> Care of CHRIS PANIATESCU <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 11731001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CHRIS PANIATESCU <br /> Title <br /> Day Phone 562-921-3581 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0013348 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner ! Facility I Account <br /> Account Name THRIFTYOIL#171 (Circle One) <br /> Account Balance as of 11512012: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner Delete <br /> 2950-ENVIRON ASSESS PRO507153 EE0000684-MICHAEL INFURNA Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this farm. I also certify that all operations will be performed in accordance with all applicable Ordfnace Codes andlor Standards and <br /> State andlor Federal Laws, <br /> APPLICANT'S SIGNATURE: Date 1 I <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 / <br /> Water System to be TRANSFERED: Amount Paid Date ! 1 <br /> Payment Type Check Number Received by <br /> REHS: Date 1 I Account out: Date I ! <br /> COMMENTS: <br /> lheh-envlenvision Sreports15021.rpt <br />