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Date nun 1/6/2014 1:35:40PM SAN JO*N COUNTY ENVIRONMENTAL HEA*DEPARTMENT Rapid#5021 <br /> Run by Pagel <br /> Facility Information as of 1/6/2014 <br /> Record Selection Criteria: Facility ID FA0002347 <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 OW0001808 New Owner ID <br /> Owner Name GIANNECCHINI, ERNEST <br /> Owner DBA ERNIE'S GENERAL STORE INC <br /> Owner Address 4407 E WATERLOO RD <br /> STOCKTON, CA 95215 <br /> Home Phone 209-931-2850 <br /> Work/Business Phone Not Specified <br /> Mailing Address 4407 E WATERLOO RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0002347 10180913 <br /> Facility Name ERNIES GENERAL STORE <br /> Location 4407 E WATERLOO RD <br /> STOCKTON, CA 95215 <br /> Phone 209-931-2850 <br /> Mailing Address 4407 E WATERLOO RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code 99-UNINCORPORATED P Alt Phone <br /> BOS District 002-RUHSTALLER, LARRY Fax <br /> APN 08710059 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name GIANNECHINI, ERNEST <br /> Title <br /> Day Phone 209-931-2850 <br /> Night Phone 209-931-2850 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0004464 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name GIANNECCHINI, ERNEST (Circle One) <br /> Account Balance as of 1/6/2014: $0.00 <br /> (Cirde One) <br /> Transfer to Active/Inach e <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1 -EETAIL MAR KET>1 QQQ SQ FT W/FOOD PREP PRO161902 EE0001084-STEPHANIE RAMIREZ Active Y N A 1 D <br /> 1920-HMBP-Common Materials PR0519729 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0518524 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511853 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PRO508381 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2361 -UST FACILITY PR0231761 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0507303 EE0000008-LETITIA BRIGGS Inactive Y N A I D- <br /> 3123-STORMWATER INSPECTION-RETAIL GAS OUT PR0523011 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532609 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 spec,PHSfEHD hourly charges associated with this facility <br /> or activity will be billed to the parry identified as the OWNER on this form. 1 also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws <br /> CkO,ASt� P c01 Z o + <br /> APPLICANTS 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 Race <br /> REHS: cJ�M/111,.1.t. Date/ 0 1_14_ Account out: Date {, /n <br /> COMMENTS: jJ.v'LSQ./1h ncCm'c (gyp I Q- v \/) „� �v, pp Vl/t•l l..F�rr1�(Jr l fOu-bU,(Q" <br />