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Date run 4/2/2009 10:29:19AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4!2/2009 <br /> Record Selection Criteria: Facility ID FA0009998 <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 OW0007998 Case Number: H06179 New Owner ID <br /> Owner Name STOCKTON DIESEL SERVICE INC <br /> Owner DBA <br /> Owner Address 2973 LOOMIS RD <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-946-0674 <br /> Mailing Address 2973 LOOMIS RD <br /> STOCKTON, CA 95205 <br /> Care of VALCONI, SHERI <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009998 <br /> Facility Name STOCKTON DIESEL SERVICE INC <br /> Location 2973 LOOMIS RD <br /> STOCKTON, CA 95205 <br /> Phone 209-946-0674 <br /> Mailing Address 2973 LOOMIS RD <br /> STOCKTON, CA 95205 <br /> Care of VALCONI, SHERI <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOIS District 001 - GUTIERREZ, STEVE Fax <br /> APN 17911025 EMail : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016998 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name STOCKTON DIESEL SERVICE INC (ClydeOne) <br /> Account Balance as of 4/2/2009: $0.00 <br /> (Cirde One) <br /> Program/Element and Description Record ID Em to ee ID antl Name Status Transfer to Activellnadve <br /> Employee New Ownert Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514126 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512286 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO520013 EEOo00000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARiPR0509998 EE000o000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO528565 EE0008317-RAYMOND VON FLUE Active,Exempt Y N A D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PR0522972 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523960 EE0003611 -FRANK GIRARDI Active Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor 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.11 be performed in accordance with all applicable Ordinace Codes and/or Stance is and <br /> State arelmr Federal Laws. //tt <br /> APPLICANT'S SIGNATURE: Date T / c� /6_ �NO <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / / t�(Q.CNn <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date / ! JU�1y <br /> lv"` <br /> Payment Types -��—Check Number Re co y <br /> REHS: — testy Date ` / 0- Account out: _ Date / / Q 1 L <br /> COMMENTS: 1 <br /> \\eh-env\envision\reports\5021.rpt <br />