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Date run 3/4/2011 12:56:42PM SAN JC -NUIN COUNTY ENVIRONMENTAL HEAT _4 DEPARTMENT Report 95021 <br /> Run byPagel <br /> Facility Information as of 3/4/201"' <br /> Record Selection Criteria: Facility ID FA0016566 <br /> Make changes/conections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013420 New Owner ID <br /> Owner Name TAYLOR, ROBERT B <br /> Owner DBA TAYLOR AUTOMOTIVE <br /> Owner Address 18711 MONTE VISTA DR <br /> LINDEN, CA 95236 <br /> Home Phone 209-931-6007 <br /> Work/Business Phone Not Specified <br /> Mailing Address 18711 MONTE VISTA OR <br /> LINDEN, CA 95236 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016566 <br /> Facility Name TAYLOR AUTOMOTIVE <br /> Location 2817 CHERRYLAND AVE STE 6 <br /> STOCKTON, CA 95215 <br /> Phone 209-931-6007 <br /> Mailing Address 18711 MONTE VISTA DR <br /> LINDEN, CA 95236 <br /> Care of TAYLOR, ROBERT <br /> Location Code 99- UNINCORPORATED A Ah Phone <br /> BOS District 002-RUHSTALLER, LARRY Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name TAYLOR, ROBERT <br /> Title <br /> Day Phone 209-931-6007 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029214 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name TAYLOR AUTOMOTIVE (Circle One) <br /> Account Balance as of 3/4/2011: $377.00 <br /> (Circle Ons) <br /> Transfer to Acmannactve <br /> Program/Element and Description Record ID Employee 10 and Name Stahl New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0524667 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0526536 Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPRO533650 Active 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 <br /> facility or activity will be billed to the parry idenfified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes andlor Standards and <br /> State endior Federal Laws. i zpE C <br /> APPLICANTS SIGNATURE: Date II <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 Receiv <br /> REHS: Z4 - - Date Account out: Date ! /iL <br /> COMMENTS: TT <br /> \\eh-env\envisionVeports\5021.rpt <br />