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Date run 7/14/2009 3:55:01 PA SAN JOARUIN COUNTY ENVIRONMENTAL HEALT.T;I DEPARTMENT <br /> Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/14/20 _ <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 <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 15908212 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name POWERS, STANLEY <br /> Title <br /> Day Phone 209-466-0841 x0 <br /> Night Phone 209-957-6229 x0 <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 (clrcleOne) <br /> Account Balance as of 7/14/2009: $0.00 <br /> (Circle One) <br /> Transfer to Active?Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PR0529459 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0522811 Active Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PR0529460 EE0009488-JEFFREY WONG Active Y N A & D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: L the undersigned owner,operator or agent of same,acknowledge that all site,anrllor project spec,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 andlor Standards and �n <br /> State and/or Federal Laws. Q nta`` <br /> N° `a`❑iV41/ <br /> APPLICANT'S SIGNATURE: Date / / Q(IQ , G <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / / Jhrn�VpVVV <br /> Water System to be TRANSFERED: $372.00= Amount Paid Dale <br /> Payment Type/ Check Number Receiv y <br /> REHS: Y\CiOdi^ a Date�_/�/_y" Account out: Date 7 6ZV cy 7 <br /> COMMENT <br /> \\eh-env\envision\reports\5021.rpt <br />