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Date mn 3/27/2009 1:51:13PK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Mnby - Paget <br /> Facility Information as of 3/27/2009 <br /> Record Selection Criteria: Facility ID FA0009188 <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 OW0007188 Case Number: H01830 New Owner ID <br /> Owner Name TERALT <br /> Owner DBA WESTERN RADIATOR <br /> Owner Address 1780 E ROOSEVELT ST <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-466-2733 <br /> Mailing Address 1780 E ROOSEVELT ST <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009188 <br /> Facility Name WESTERN RADIATOR <br /> Location 1780 E ROOSEVELT ST <br /> STOCKTON, CA 95205 <br /> Phone 209-466-2733 <br /> Mailing Address 1780 E ROOSEVELT ST <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 14108301 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 AR0016188 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name WESTERN RADIATOR (Circle One) <br /> Account Balance as of 3/27/2009: $0.00 <br /> (Circle One) <br /> Program/Element and Description Record ID Employee ID and NameStatus Transferto Active/Inachve <br /> New Omen Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0513692 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511476 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO519446 EE00o0000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0509188 EE0000000-HAZ MAT SJC OES Inactive 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,PMS/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 Ordinate Codes and/or Standards and <br /> State and/or 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 b <br /> REHS Date / 2 meq Account out: _ Date 3 / .3D /D 9 <br /> COMMENTS: T <br /> \\eh-env\envision\reports\5021.rpt <br />