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Date nin 8/27/2014 10:22:06AI SAN JO IN COUNTY ENVIRONMENTAL HEA*DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/27/2014 <br /> Record Selection Criers: Facility ID FA0009244 <br /> Make changes/corrections 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 OW0007244 Case Number: H02342 New Owner ID <br /> Owner Name KAWAR, ISAAC <br /> Owner DBA <br /> Owner Address 3250 N WILSON WAY <br /> STOCKTON, CA 952052515 <br /> Home Phone 209-948-4836 <br /> Work/Business Phone Not Specified <br /> Mailing Address 3250 N WILSON WAY <br /> STOCKTON, CA 952080421 <br /> Care of KAWAR, ISAAC <br /> FACILITY FILE INFORMATION <br /> Facility ID if CERS ID FA0009244 10182541 <br /> Facility Name CONVENIENT CAR CARE/EUROPEAN MOT <br /> Location 3250 N WILSON WAY <br /> STOCKTON, CA 952052520 <br /> Phone 209-948-4836 <br /> Mailing Address 3250 N WILSON WAY <br /> STOCKTON, CA 952052520 <br /> Care of KAWAR, ISAAC <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 11904334 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 AR0016244 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CONVENIENT CAR CARE/EUROPEAN MOTORS (Circle One) <br /> Account Balance as of 8/27/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1920-HMBP-Common Materials PRO519488 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<6 TONS/YR PRO513721 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511632 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509244 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PR0522996 EE0009488-JEFFREY WONG Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO537135 EE0002620-ALFONSO ARAMBULA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531945 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,PHS,EHD hourly charges associated with this facility <br /> or activity will be billed to the party identifed 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 ardor <br /> Federal Laws. <br /> APPLICANTS 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 />