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Date run 10/8/2013 11:53:44AI SAN JO IIN COUNTY ENVIRONMENTAL HEA' ' DEPARTMENT Reponu5021 <br /> Ran byPagel <br /> Facility Information as of 10/8/2013 <br /> Record Selection Criteria: FacilityID FA0019300 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0016842 New Owner ID <br /> Owner Name PAUL &AMARJIT SINGH <br /> Owner DBA PAUL'S TRUCK WASH INC <br /> Owner Address 500 TRUCK INN WAY <br /> FERNLEY, NV 89408 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-948-4451 <br /> Mailing Address 500 TRUCK INN WAY <br /> FERNLEY, NV 89408 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0019300 10,187,185 <br /> Facility Name PAULS TRUCK WASH INC <br /> Location 1524 FRESNO AVE <br /> STOCKTON, CA 95206 <br /> Phone 209-948-4451 x0 <br /> Mailing Address 500 TRUCK INN WAY <br /> FERNLEY, NV 89408 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16337027 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034314 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name PAUL &AMARJIT SINGH (Cimle One) <br /> Account Balance as of 10/8/2013: $0.00 <br /> (Circle One) <br /> Transfer to Active9nactve <br /> Progra"Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO528737 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534779 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project speck,PHSrEHD hourly charges associated with this facility <br /> or activity will be billed to the party,identified as the OWNER on Nis form I also certify that all operations will be performed in accordance min all applicable Ordinance Codes andor Standards and State andor <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 /> REHS: Date / / Account out: Date I / <br /> COMMENTS: <br />