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Date run 5%22/2014 1:17:21 Ph SAN JUIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 5/22/2014 <br /> Record Selection Criteria: Facility ID FA0012440 <br /> Make changeslcorrectidns in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 5 SSN I 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 901-495-6500 <br /> Mailing Address 123 South Front Street <br /> Memphis, TN 38103 <br /> Care of PECORD, PHIL <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0012440 10140043 <br /> Facility Name AUTO ZONE STORE#5685 <br /> Location $228 WEST LN <br /> STOCKTON, CA 95210 <br /> Phone 209-957-1108 <br /> Mailing Address 123 S FRONT ST <br /> MEMPHIS, TN 38103 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 09056003 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 AR0020297 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner ! Facility I Account <br /> Account Name AUTO ZONE STORE#5685 (Circle One) <br /> Account Balance as of 5/22/2014: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Flement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0520851 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 2221 -USED OIL ONLY-c5 TONSIYR PR0516058 EE0005642-MICHELLE HENRY Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO515059 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0516060 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: E,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be Nlled 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 andor Standards and State andtor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: Amount Paid Date 1 ! <br /> Payment Type Check Number Receiv d <br /> REHS: Date 1 1 Account out: Date 1 !� <br /> COMMENTS: <br />