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01/15/2013 13:30 2094603433 SJC EHD UNIT 3 PAGE 02/02 <br /> Oak i% ln5rz0l3 1:23:29PI, SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Reamtasoxl <br /> R.,,by <br /> Facility Information as of 1/15/2013 Papas <br /> RaNsd baleawn c.a: Facial IU FAD012425 <br /> Make changeahwrractlons in RED Ink. 1-15-13 <br /> INFORMATION CHANGE(dale) <br /> OWNERSHIP CHANGE(dole) 17/1/12 <br /> OWNER FILE INFORMATION SSN/Fed Tax to • 95-3675830 <br /> Owner ID OW0009635 New Owner ID . <br /> Ovmer Neme FREMOUW ENVIRONMENTAL SERVICES IP Asbury Fiiviu)pnlenlal Services <br /> Owner DOA CALIFORNIA COOLANT SERVICE <br /> owner Address 1187 VANDERBILT CIR#2 1187 Vanderbilt Cir.#2 <br /> MANTECA,CA 95337 �Qp g337 <br /> Home Phona Not Specified Nol0Aica lc� <br /> WorklBusit ess Phone 209-239-5587 000-119-5597 <br /> Mailing Address 1187 VANDERBILT CIR#2 _1187 Vanderbilt..Cir.-#9 <br /> MANTECA, CA 95337 Manteca. CA 05337 _ <br /> Cam of <br /> FACILITY FILE INFORMATION <br /> Facility to FA0012425 <br /> Facility Name CALIFORNIA COOLANT SERVICE As Ury Environmental Services <br /> Loranon 1187 VANDERBILT CIR 2 1187 Vand_e1'bilt Cir. 92 <br /> MANTECA, CA 95336 Manteca, CA 95336 <br /> Phone 209-239-5587 _ 209-239-5587 <br /> Mailing Address 1187 VANDERBILT CIR#2 1300 South Santa Fe Avenue <br /> MANTECA, CA 95337 Campton, CA 90221 <br /> Care of FREMOUW ENVIRONMENTAL SERVICES IP Rncr na v Il 23 <br /> LDcahon code 04-MANTECA Aq PPDIM 323-855-4523 <br /> BOS District 005-ORNELLAS, LEROY Fax 323-268-0925 <br /> APN 22119016 EMi. rrinmi,nD(y]aabnrvenv cpm <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Rui GOncalves <br /> Title <br /> Day Phone 22 <br /> Night Phone 909-481-7992 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account to AR0020282 Now Account to <br /> Mail Invoices to Facility Mail Invoices to. Owner / FacA17y I Amount <br /> ACmUnt Name CALIFORNIA C OLANT SERV (mak Onat <br /> Account Balance as Of 1/15/2013: !9' /0, i/ �1.; <br /> Tnamkl p PdrD*Sate e <br /> EWnanlaw DtY/,IIYp.I Ra[oM ID Emgea pID said Name buua <br /> Naw OMar9 Dwaa <br /> 1921-)HMOP-Regular-Primary Location PRO52D91 O EE0002474-MICHAEL PARISSI Active Y N A I D <br /> -SM IIW GEN<5 TONS/YR PRO51622T EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2224-HA7 MAT BUSINESS PLAN AUTHORIZATIOIPROSIS023 EE0000000-HAZ MAT SJC DES Inactive Y N A 1 0 <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO516024 EED000000-HA2 MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPRO532500 Ineaive, Y N A 1 O <br /> eYaaNe a Me COMvII10 C M�IVlD .w,as WeO OWNER <br /> MISk,im. IMISS,or..av raervq...w,.ero.�.ee.erl at ua.ala'>G•+nvro we rl leEND n,✓y ore..w.wnmwF Wafa�tlxy <br /> vadrvM/nYbMil✓)Ic ey pO:y Wal/�w as Vr OWNEa bl Fk brt. I.4o Ga,lay Ia110{a1.1W wnM pMlplMe Na[CU6M w.ln all apP'ctl'.Ia Q4VY14i Cg1n w+Yp blvWW�tl bWtaMY <br /> Ga•Je,tl Lara <br /> Irv^, <br /> APPLICANT'S SIGNATURE -J! /LAW Date /�`✓ /�96 <br /> I <br /> Program Records to be TRANSFERED: 'X25.00 e_ Amount Paxl Date <br /> Wafer Syatenl to be TRANSFERED Amount Paid Date-_/_l_ <br /> Payment Type Check Number I z Recerva0 y <br /> RENS: -l'✓I AJ<ilf>-ZA Date /�/ Account out' _ Dab <br /> COMMENTS' <br /> Qui Z � 13I 13 <br />