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Data coli 11/10/2017 9:24:39AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/10/2017 <br /> Record Selection Clients: Facility ID FA0023733 <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 to <br /> Owner to OW0022070 New OwnerlD <br /> Owner Name TERA INVESTMENTS INC <br /> Owner DBA SUNWEST CHEVRON <br /> Owner Address 4810 CHILES RD <br /> DAVIS, CA 95618 <br /> Home Phone 530-753-7129 <br /> Work/Business Phone Not Specified <br /> Mailing Address 4810 CHILES RD <br /> DAVIS, CA 95618 <br /> Care of MUNDY, DARSHAN <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0023733 <br /> Facility Name SUNWEST CHEVRON <br /> Location 2758 W KETTLEMAN LN <br /> LODI, CA 95242 <br /> Phone 916-417-8860 <br /> Mailing Address 4810 CHILES RD <br /> DAVIS, CA 95618 <br /> Care of MUNDY, DARSHAN <br /> Location Code Alt Phone <br /> BOB District Fax <br /> APN EMail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MUNDY, DARSHAN <br /> Title <br /> Day Phone 916-417-8860 <br /> Night Phone 530-753-7129 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account to AR0043919 New AccountlD: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SUNWESTCHEVRON (CInleOne) <br /> Account Balance as of 11/10/2017: $0.00 <br /> (Circle one) <br /> Transrerto Advellnactve <br /> PrograMElement and Desorption Record ID Employee lD and Name Status New nmp Delete <br /> 1615-RETAIL MKT 301-2000 SO FT(PREPKGD/LTD PREP) PRO542314 EE0001084-STEPHANIE RAMIREZ Active Y N A I D <br /> 2351-UST FACILITY-2481 COMPLIANT PR0541416 EE0000030-AARON HANG Active Y N A I D <br /> eILLINGand COMPLIANCEACKNOw DGEMENT: I,the underalgned owner,operatormagent ofsame,acknowledgethat all site,and/or project specific,PHSEHD hourly charges associated with Nisracillty, <br /> or activity will be billed to the patty Identified as Ne OWNER on this form. I also cetify that all operations will be perrormed in accordance with all applicable Ordinance Codes antllor Standards and State andlpr <br /> Federal Lows. <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 1 Received by�—� <br /> EHD Staff: uryn \%,&o � — Date�/1(L/ � a Account out: Data <br /> e <br /> u-r �r 2 <br /> COMMENTS: n ^3 (3 <br /> Invoice#: v <br /> Af)J -)—U o� �� <br />