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Datemn - -0,,.812010 4:44:07PM SAN JOA'!"TIN COUNTY ENVIRONMENTAL HEALT^7EPARTMENT Report#5021 <br /> Rena Facility Information as of 3/3/2010"k Pwef <br /> Record Selection Criteria: Facility ID FA0009078 <br /> Make changes/corrections in RED ink. C� <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0007078 Case Number: H00938 New Owner ID <br /> Owner Name CURTISFREIH <br /> Owner DBA FREIH'S AUTO REPAIR <br /> Owner Address 916 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-368-5689 <br /> Mailing Address 916 BLACK DIAMOND WAY#B <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009078 <br /> Facility Name FREIHS AUTO REPAIR <br /> Location 916 BLACK DIAMOND WAY B <br /> LODI, CA 95240 <br /> Phone 209-368-5689 <br /> Mailing Address 916 BLACK DIAMOND WAY#B <br /> LODI, CA 95240 <br /> Care of <br /> Location Code 02 - LODI Alt Phone <br /> Bos District 004-VOGEL, KEN Fax <br /> APN 04917016 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 AR0016078 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility ! Account <br /> Account Name FREIHS AUTO REPAIR tckde,Onel <br /> Account Balance as of 3/3/2010: $362.00 <br /> /Circle 0.1 <br /> Transfer to Active/Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status New 0w se Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0513623 EE0001422-ARIS CACAPIT Active Y N A I ' D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511366 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO519365 EE0000000-HAZ MAT SJC CES Active Y N A 1 D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAReR0509078 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0532853 Active Y N A I D <br /> BILLING end COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or protect specific,PHS/EHO hourly charges associated wah this <br /> facility or activity wiA be filled to the parry identified as the OWNER on this form. I also certify that all operations will be performed in accordance Win all applicable Ordinace Codes andlor Standards and <br /> Slate artNor Federal Leon;. <br /> APPLICANTS 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 Recei d <br /> RENS: Date t0 Account out: <br /> COMMENTS: <br /> �it�'�/rnJ✓"' U(/W <br /> \\eh-env\envision\reports\5021.rpt <br />