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Date run 3/27/2015 12:50:52PI SAN JOIN COUNTY ENVIRONMENTAL HEA�EPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/27/2015 <br /> Record Selection Criteria: Facility ID FA0010342 <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: 2 SSN/Fed Tax ID : <br /> Owner ID OW0008342 Case Number: H07808 New Owner ID : <br /> Owner Name FRANCES LEE <br /> Owner DBA FRENCH CLEANERS <br /> Owner Address 416 W YOSEMITE AVE <br /> MANTECA, CA 953375503 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-601-4583 <br /> Mailing Address 416 W YOSEMITE AVE <br /> MANTECA, CA 95337-5503 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0010342 10183469 <br /> Facility Name FRENCH CLEANERS <br /> Location 416 W YOSEMITE AVE <br /> MANTECA, CA 95337-5503 <br /> Phone 209-823-5533 x <br /> Mailing Address 416 W YOSEMITE AVE <br /> MANTECA, CA 95337 <br /> Care of Frances Lee <br /> Location Code 04- MANTECA Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 21931203 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 AR0017342 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name FRANCES LEE (Circle One) <br /> Account Balance as of 3/27/2015: $0.00 <br /> (Circle One) <br /> Transferto Activellnal <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520272 EE0002474-MICHAEL PARISSI Active Y N A 01 D <br /> 2220-SM HW GEN<5 TONS/YR PRO514290 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512630 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510342 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533288 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andoir project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this farm. I also certify that all operations will be performed in accomance with all applicable Ordinance Codes andor Standards and State endor <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 i/ 3\ /fit Account ouCtjk� _ Date_/ / �S <br /> COMMENTS: <br />