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Date run 3/11/2009 4:56:32Ph SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 3/11/2009 <br /> Record Selection Criteria: Facility 10 FA0013530 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) 21, <br /> (/ OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0010656 New Owner ID <br /> Owner Name VINTAGE INVESTMENTS <br /> Owner DBA STOCKTON AUTO CARS <br /> Owner Address PO BOX 457 <br /> LODI, CA 95240 <br /> Home Phone Not Specified Fre1t n—., <br /> Work/Business Phone 209-320-7900 <br /> Mailing Address 3717 W WEST LN <br /> STOCKTON, CA 95204 <br /> Care of eSAN J0ap6AN <br /> � � <br /> FiG 0` EEMERG.. — <br /> FACILITY FILE INFORMATION SERVICES <br /> Facility ID FA0013530 <br /> Facility Name STOCKTON AUTO CARS INC <br /> Location 3717 WEST LN <br /> STOCKTON, CA 95204 <br /> Phone 209-320-7900 <br /> Mailing Address 2002 E HAMMER LN <br /> STOCKTON, CA 95210 <br /> Care of STOCKTON HONDA <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 11530050 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 AR0022634 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name STOCKTON AUTO CARS INC Garde One) <br /> Account Balance as of 3/11/2009: $382.00 <br /> (Circle One) <br /> Transfer to Activa/InacNe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0517629 EE0004636-GARRETT BACKUS Active Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0517631 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO521085 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399.UNIFIED PROGRAM FAC STATE SURCHARPR0517630 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$20.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Received y <br /> RENS: Date _lL l� Account out: Date =—L71—Py <br /> COMMENTS: <br /> \\e h-env\envision\reoorts\5021.rot <br />