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Daterun ,4/9/2013 3:10:21PM SAN JOWIN COUNTY ENVIRONMENTAL HEADEPARTMENT Report#5021 <br /> Run by Pagel <br /> + Facility Information as of 4/9/20 <br /> Record Selection Criteria: Facility ID FA0018094 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> \� OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION V SN/Fed Tax ID <br /> Owner ID OW0014840 New Owner ID <br /> Owner Name DAVILA, CESAR pp <br /> Owner DBA n 1,3 Owner Address 1818 TORINO DR /Y <br /> STOCKTON, CA 952052564 <br /> Home Phone 209-817-3711 <br /> Work/Business Phone 209-469-3882 <br /> Mailing Address 1818 TORINO DR <br /> STOCKTON, CA 952052564 <br /> Care of DAVILA, CESAR <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0018094 10,186,753 <br /> Facility Name MASTER AUTO REPAIR <br /> Location 3091 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Phone 209-817-3711 <br /> Mailing Address 1818 TORINO DR 36,11 51yrt z <br /> STOCKTON, CA 952052564 9 <br /> Care of DAVILA, CESAR <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 11904225 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 AR0031829 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MASTER AUTO REPAIR (Circle One) <br /> Account Balance as of 4/9/2013: $3,411.30 <br /> (Circle One) <br /> Transfer to Active'Inacive <br /> ProgramdElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0530836 Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0526723 EE0004636-GARRETT BACKUS Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PRO633730 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all ails,andror project specific,PHS/EHD hourly charges associated with this facility <br /> or eaivity 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 / / <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 R Iv <br /> REHS: G Date /�'o / Account out: Date / /L <br /> COMMENTS: <br />