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Date run 4^d114/,1014 10:16:55AISAN�QUIN COUNTY ENVIRONMENTAI�HEOM DEPARTMENT Report#5021 <br /> Run by 1273 Pagel <br /> Facility Information as of 8/14/2014 <br /> Record Selection Criteria: Facility ID FA0020059 <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 tD OW0016464 New Owner ID : <br /> Owner Name NAPOLES, JUAN :2 AAECA&J 101 <br /> Owner DBA <br /> Owner Address 941 BRYCE WAY <br /> TRACY, CA 95376 <br /> Home Phone 209-860-6700 <br /> WoWBusiness Phone 209-321-6825 <br /> Mailing Address 4023 Castellina way <br /> manteca, CA 95337 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0020059 10187497 7 jIV !tr!`✓ 1 �1� ._ <br /> Facility Name 2 MECHANICS AUTO REPAIR <br /> Location 24584 MACARTHUR <br /> TRACY, CA 95376 <br /> Phone 209-830-6700 x <br /> Mailing Address 24584 MACARTHUR <br /> TRACY, CA 95376 <br /> Care of NAPOLES, JUAN <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 25024001 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 AR0035754 New Account ID: <br /> Mail Invoices to Facility Mail invoices to: Owner 1 Facility 1 Account <br /> Account Name 2 MECHANICS AUTO REPAIR (Circle One) <br /> Account Balance as of 811412014: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO539239 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN a5 TONSNR PRO631142 EE0002646-THUY TRAN Active Y N A 1 D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532777 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project specific,PHSfEHD hourly charges associated with this family <br /> or activity wilt be billed to the party identified as the OWNER on this form. I also certify that all operationswill be performed in accordance with all applicable Ordinance Codes andlor Standards and State andior <br /> Federal Laws, <br /> APPLICANTS SIGNATURE: Date ! 1 <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date ! / <br /> Water System to be TRANSFERED: Amount Paid Date / 1 <br /> Payment Type Check Number Recejv <br /> REHS: Date ! 1 Account out: Date <br /> COMMENTS: <br /> uv- aid a s h-,vh <br /> You'-2WV s-5 <br />