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Date run 12/15/2014 2:54:41P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENTjRepaRun by ' Facility Information as of 12/1512014Record Selection Criteria: Facility ID FA0015385 <br /> Make changeslcorrections in REDink. O /INFORMATION CHANGE(date) 1 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0012353 New Owner ID <br /> Owner Name SINGH, SURINDER <br /> Owner DBA S &S AUTO SALES REPAIR SHOP <br /> OwnerAddress 845 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 845 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0015385 10184935 <br /> Facility Name S&S AUTO SALES REPAIR SHOP <br /> Location 819 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Phone 209-462-7327 <br /> Mailing Address 845 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 15107505 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Jose Gonzalez <br /> Title Business Manager <br /> Day Phone 209-462-7327 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026499 New Account ID: <br /> L <br /> Mail Invoices to Facility t /t '( (,1J / �S Q Mail Invoices to: Owner / Facility / Account <br /> Account Name S&S AUTO SALES REPAIR SHOP� (arae one) <br /> Account Balance as of 12/15/2014: $0.00 /�/ nao <br /> (Circle One) <br /> (�'' 11 Transfer to Acdi eJlnactve <br /> Program/Element and Description Record ID Employee ID and Name �Z�3Yahis New Owner, Delete <br /> 1920-HMBP-Common Materials PR0523286 EE0000006-HAZA SAEED Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PR0522581 EE0009488-JEFFREY WONG Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO531584 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project spacing,PHS`EHD hourly charges associated with this facility <br /> or adivby will be billed to the party identified as the OWMER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / I <br /> Water System to be TRAN$FERED: Amount Paid Date <br /> Payment Type / Check Number Received by <br /> REHS: Date. / / Account out: Date 1.2- 117 / d <br /> COMMENTS: <br />