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Date run 10/4/2021 10:21:12AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/4/2021 <br /> Record Selection Criteria: Facility ID FA0003741 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0002779 New Owner ID <br /> Owner Name Broadbase Inc <br /> Owner DBA <br /> OwnerAddress 1471 SHORE ST <br /> WEST SACRAMENTO, CA 956913512 <br /> Work/Business Phone 916-375-1155 <br /> Alternative Phone 916-375-1155 <br /> Mailing Address 1471 SHORE ST <br /> WEST SACRAMENTO, CA 95691-3512 <br /> Care of <br /> FACILITY FILE INFORMATION APN 15120405 Site Mitigation Facility <br /> Facility ID/CERS ID FA0003741 10181367 <br /> Facility Name JIFFY LUBE#598 <br /> Location 1130 N MAIN ST <br /> MANTECA, CA 95336 <br /> Phone 209-239-0665 x <br /> Mailing Address 1471 SHORE ST <br /> WEST SACRAMENTO, CA 95691-3512 <br /> Care of BROADBASE INC <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003320 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Glen Ganotls (Circle One) <br /> Email invoice to(up to 2 emails) AP@JIFFYLUBECA.COM <br /> Email permit to(up to 2 emails) AP@JIFFYLUBECA.COM <br /> Account Balance as of 10/4/2021: $2,919.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location 8 chem units PR0519894 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2215-USED OIL COLLECTION CENTER PR0546754 EE0000033-PAUL NSO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512110 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2229- EN 50<250 TONS PERMIT PR0514050 EE0000033-PAUL NSO Active Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PR0507691 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 2332-EXEMPT TANK FACILITY PR0528432 EE0000032-JOHN ALANIZ Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0232332 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FE PR0507430 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0523340 EE0000033-PAUL NSO Active Y N A I D <br /> 3528-LOP CLOSED SITE PR0544417 Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE PRO532975 Inactive Y N A I D <br />