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Date run 12/15/2014 1:27:44P SAN JOiIN COUNTY ENVIRONMENTAL HEA#DEPARTMENT <br /> Report#5021 1 <br /> Run by Pagel <br /> Facility Information as of 12/15/2014 <br /> Record Selection Catena: Facility ID FA0009543 <br /> Make changeslcorrections In RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0007543 Case Number: H04792 New Owner ID : <br /> Owner Name GOODMAN, ERIC <br /> Owner DBA A-1 TRANSMISSIONS INC <br /> Owner Address 2523 MEDICI CT <br /> STOCKTON, CA 95207 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-477-1492 <br /> Mailing Address 3132 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0009543 10182767 <br /> Facility Name A-1 TRANSMISSIONS INC <br /> Location 3132 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Phone 209-466-0151 <br /> Mailing Address 3132 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 11904228 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 AR0016543 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name GOODMAN, ERIC (Circle One) <br /> Account Balance as of 12/15/2014: $0.00 <br /> (circle one) <br /> Transfer to Activellnai <br /> Pragram/Element and Description Record ID Employee ID and Name Status New Owner Delete <br /> 1920-HMBP-Common Materials PR0521216 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0513895 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511831 EE00o0000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509543 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PRO622993 EE0009488-JEFFREY WONG Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533959 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHShEHD 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 anNor Standards and Stale andor <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 Received by <br /> REHS: Date_/_/ Account out: Date <br /> COMMENTS: <br />