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Date run 9/23/2013 9:25:OOAA SAN JUIN COUNTY ENVIRONMENTAL HEAV DEPARTMENT Report#6021 <br /> Run by Pagel <br /> Facility Information as of 9/23/2013 <br /> Record Selection Criteria: Facility ID FA0009711 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0007711 Case Number: H05199 New Owner ID <br /> Owner Name BREWER ENTERPRISES INC <br /> Owner DBA MIDAS AUTO SERVICE EXPERTS <br /> Owner Address 1478 CAMILLA ST <br /> MANTECA, CA 95337 <br /> Home Phone 408-506-5064 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1478 CAMILLA ST <br /> MANTECA, CA 95337 <br /> Care of BREWER, BILL <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0009711 10,182,835 <br /> Facility Name MIDAS AUTO SERVICE EXPERTS <br /> Location 5897 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone 209-951-5685 <br /> Mailing Address 5897 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 10812032 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 AR0016711 New Account ID: <br /> Mail Invoices to Facility t Mail Invoices to: Owner / Facility / Account <br /> Account Name MIDAS AUTO SERVICE EXPERTS (Circle one) <br /> Account Balance as of 9/23/2013: $0.00 C�� 0 31T . ) <br /> ��� �p . / C Circle One <br /> G'lY-r"rT 9 ZQ ufq 0,-� � Transfer to AdiveMactve <br /> ProgreM and Description C� -1�- ,10 Cop <br /> i Record ID Employee ID and Name Status New Owner? Delete <br /> MBP gut rimary Location PRO519815 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511999 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PRO517870 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509711 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0523248 EE0009000-HARPRIT MATTU Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534519 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acimowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form Ialso certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State andor <br /> Federal Levis. <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 Re v d <br /> REHS: Date 17 L/3 Account out: Date <br /> COMMENTS: <br /> 2vA4 3 ( �� <br />