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7 <br /> ' { � } Report#5021 <br /> Date run 5/221 1:18:22PR SAN J�,. UIN COUNTY ENVIRONMENTAL HEAAw'H DEPARTMENT <br /> Run by Pagel <br /> Facility Information as of 5/22/2014 <br /> Record Selection Criteria: Faeifity ID FA0012440 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 5 SSN/Fed Tax ID <br /> Owner ID OW0008924 Case Number: H08981 New Owner ID <br /> Owner Name AutoZone Stores Inc. <br /> Owner DBA AUTO ZONE <br /> Owner Address 123 S FRONT ST <br /> MEMPHIS, TN 381033607 <br /> Home Phone Not Specified <br /> Work/Business Phone 901495-6500 <br /> Mailing Address 123 South Front Street <br /> Memphis, TN 38103 <br /> Care of PECORD, PHIL <br /> FACILITY FILE INFORMATION <br /> Facility ID/CE RS ID FA0012440 10140043 <br /> Facility Name AutoZone#5685 <br /> Location 8228 West Ln <br /> Stockton, CA 95210 <br /> Phone 209-957-1108 x <br /> Mailing Address' Dept 8190, 123 South Front Street <br /> Memphis, TN 38103 <br /> Care of Mark Rohme <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> i-. <br /> Account ID AR0020297 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name AutoZone#5685 (Circle One) <br /> Account Balance as of 5/22/2014: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> PrograrnlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520851 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 2221 -USED OIL ONLY-<5 TONS/YR PRO516058 EE0005642-MICHELLE HENRY Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0516059 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO516060 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534330 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT', I,the undersigned owner,operator or agent of same,acknowledge that alt site,and/or project specific,PHSfEHD hourly charges associated with this facility <br /> 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 Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 ! <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Recel y <br /> RENS: Date / ! Account out: _ Date <br /> COMMENTS: <br />