Laserfiche WebLink
Date r 7-3/2022 3:15:16PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/13/2022 <br /> Record Selection Criteria: Facility ID FA001016{{2 <br /> Make changes/corrections in RED ink. G <br /> lip 2- i INFORMATION CHANGE(date) a Z Z <br /> r OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0008162 New Owner ID <br /> Owner Name SIMPSON, BOBBY SR v '4 - 41 L 'L <br /> Owner DBA <br /> OwnerAddress 5236 E DANA AVE ?p 2 ,.:; !<<.��r e ✓t� �1`' <br /> STOCKTON, CA 95215 t Z-i G <br /> Work/Business Phone 209-934-1-1-70- Ci 2�/N, `/ <br /> Alternative Phone 209-430-4-806-,---- - <br /> Mailing Address 2953 CHERRYLAND AVE#B <br /> STOCKTON, CA 952152233 <br /> Care of SIMPSON, BOBBY SR /' -y2vt �-�a�✓c.� <br /> FACILITY FILE INFORMATION APN 08710046 <br /> Facility ID/CERS ID FA0010162 10183281 <br /> Facility Name DIFFERENTIALS PLUS �ie fe 1•f A-- •c ,w r, h. <br /> Location 2953 CHERRYLAND AVE STE B <br /> STOCKTON, CA 95215 <br /> Phone 209-931-1170 2-0�j - Z ci - c3 3 in `J <br /> Mailing Address 2953 CHERRYLAND AVE STE B <br /> STOCKTON, CA 952152233 <br /> Care of SIMPSON, BOBBY-SR-- [•1'- tet, <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name SIMPSON, BOBBY SR <br /> Title Owner <br /> Day Phone 209-931-1170 • n <br /> Night Phone 209-430-1806 �— <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017162 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name DIFFEREtVTf S PLU (Circle One) <br /> Email invoice to(up to 2 emails) <br /> Email permit to(up to 2 emails) - <br /> Account Balance as of 7/13/20$93 <br /> (Circle One) <br /> Program/Element and DescriptionRecord ID Employee ID and Name Status Transferto Active/inactve <br /> New Owner? Delete <br /> 1920-HMBP-Common Materials 3 chem units PR0520111 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2221 -USED OIL ONLY-<5 TONS/YR PRO514207 EE9999998-ONE VACANTI Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512450 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FE PRO510162 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PRO522965 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE PRO532890 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,PHS/EHD hourly charges associated with this facility <br /> 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 Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / ! <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date <br /> Water System to be T NSFERED: Amount Paid Date <br /> Payment Type _Check Number Received by <br /> EHD Staff: Date /. ---Account out: APT Date_7/ 19 / 2022 <br /> COMMENTS: l � f ' :�Z357194 <br /> Invoice#: <br /> / „✓ <br />