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Date run 4/20/2015 11:48:28AI SAN JO. AN COUNTY ENVIRONMENTAL HEAI DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4/20/2015 <br /> Record Selection Criteria: Facility ID FA0014397 <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 OW0011439 New Owner 10 <br /> Owner Name VINTAGE INVESTMENTS <br /> Owner DBA TOYOTA TOWN SERVICE ANNEX <br /> Owner Address 2188 E HAMMER LN <br /> STOCKTON, CA 95210 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-473-2513 <br /> Mailing Address 2188 E HAMMER LN <br /> STOCKTON, CA 95210 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0014397 10184625 <br /> Facility Name TOYOTA TOWN SERVICE ANNEX <br /> Location 2188 E HAMMER LN <br /> STOCKTON, CA 95210 <br /> Phone 209-473-2513 x <br /> Mailing Address 2188 E HAMMER LN <br /> STOCKTON, CA 95210 <br /> care of TOYOTA TOWN SERVICE ANNEX <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 002 - MILLER, KATHERINE Fax <br /> APN 09406059 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 AR0024477 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name TOYOTA TOWN SERVICE ANNEX (cirde One) <br /> Account Balance as of 4/20/2015: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name Suisse New Ow ieR Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519255 EE0000006-HAZA SAEED Active Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PR0531186 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0528286 EE0000005-FATINAH ZAREEF Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO522800 EE0002620-ALFONSO ARAMBULA Inactive Y N A 1 D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531798 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 specific,PHSIEHD 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 andor Standards and State endo, <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 <br /> COMMENTS: <br />