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Deterun -3/27/2009 11:44:OOAI SAN JOA'-TIN COUNTY ENVIRONMENTAL HEALT'i DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 3/2712005 Paget <br /> Record Selection Criteria: Facility ID FA0015543 <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 OW0012495 New Owner ID <br /> Owner Name STANLEY POWERS <br /> Owner DBA CHARLIES AUTO PARTS & HARDWARE <br /> Owner Address 4515 E MAIN ST <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-957-6229 <br /> Mailing Address 4515 E MAIN ST <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION pp <br /> Facility ID FA0015543 <br /> Facility Name CHARLIES AUTO PARTS& HARDWARE <br /> Location 4515 E MAIN ST <br /> STOCKTON, CA 95215 <br /> Phone 209-466-0841 x0 <br /> Mailing Address 4515 E MAIN ST <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 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 AR0026834 NewAccount ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name STANLEY POWERS (Circle One) <br /> Account Balance as of 3/27/2009: $321.00 <br /> (Circle One) <br /> Transferto Active/Inadve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2244-PACT TRANSFER RECORD-DES PRO522811 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 spec,PHS/EHD hourly charges associated with this <br /> fetidly or activity will be billed to the party Identified as the OWNER on this form. 1 also teddy that all operations will be performed in accordance with all applicable Ordinate Codes and mr Standards and <br /> Slate anther 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 '3 / _(�� Account out l���J Data <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />