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Date run 7/8/2015 10:34:37AM SAAQUIN COUNTY ENVIRONMENTAL TH DEPARTMENT Report#5021 <br /> Run by ro Pagel <br /> Facility Information as of 7/8/2015 <br /> Record Selection Criteria: Facility ID FA0003789 <br /> Make changes/corrections 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 OW0000141 New Owner ID <br /> Owner Name CARDOZA, ED & DOLORES <br /> Owner DBA TWO GUYS FOOD & FUEL <br /> Owner Address 147 E LATHROP RD <br /> LATHROP, CA 95330 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-239-4141 <br /> Mailing Address 147 E LATHROP RD <br /> LATHROP, CA 95330 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0003789 10181421 <br /> Facility Name TWO GUYS FOOD& FUEL <br /> Location 147 E LATHROP RD <br /> LATHROP, CA 95330 <br /> Phone 209-858-2666 x <br /> Mailing Address 147 E LATHROP RD <br /> LATHROP, CA 95330 <br /> Care of JARNAILKAMBOJ <br /> Location Code 07- LATHROP Alt Phone <br /> BOIS District 003- BESTOLARIDES, STEVE Fax <br /> APN 19608071 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 AR0003374 New Account Mr. <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name TWO GUYS FOOD & FUEL (Circle One) <br /> Account Balance as of 7/8/2015: $0.00 <br /> (Cirde <br /> Transfer to Adive9r <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delf <br /> 1920-HMBP-Common Materials PRO520486 EE0002474-MICHAEL PARISSI Active Y N A 1 <br /> 2220-SM HW GEN<5 TONS/YR PR0518130 EE0002646-THUY TRAN Active Y N A 1 <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513068 EE0000000-HAZ MAT SJC OES Inactive Y N A 1 <br /> 2301 -UST STATE SURCHARGE FEE PRO507728 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I <br /> 2361 -UST FACILITY PR0232353 EE0002646-THUY TRAIN Active Y N A 1 <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0507465 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO533802 Inactive Y N A I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSrEHD hourly charges associated with this f: <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 ander Standards and State a <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: Invoice#: <br />