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Date run 2/6/2013 8:44:57AM Run by SAN JC IN COUNTY ENVIRONMENTAL HEA, Facility Information as of 2/6/2013 DEPARTMENT Report#5021 Pagel Record Selection Criteria: Facility ID FA0010816 r' Make changes/corrections inQ i¢t INFORMATION CHAtq �/V OWNERSHIP CHANGE (date) OWNER FILE INFORMATION Owner ID OW0008816 Case Number: H08804 Owner Name REAMES, SHANE/WAGENMAN, DAVID Owner DBA Bos District Owner Address 12606 MUNDY LN 11707050 LODI, CA 95240 Home Phone Not Specified Work/Business Phone 209-547-0443 Mailing Address PO BOX 55242 D STOCKTON, CA 95205 Care of REAMES, SHANE/WAGENMAN, DAVID FACILITY FILE INFORMATION Facility ID FA0010816 Facility Name SHANE & DAVES TRUCK SHOP INC Location 2383 N WILSON WAY STOCKTON, CA 95205 Phone 209-547-0443 Mailing Address PO BOX 55242 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION 6rVic � Account ID AR0017816 0 << Mail Invoices to Facility Account Name SHANE & DAVES TRUCK SHOP INC Account Balance as of 2/6/2013: $0.00 Fr P a`Element and Description Record ID Employee ID and Name SSN / Fed Tax ID New Owner ID -moo t- Li b 7- b6 C, �AL� rC_v cel e. 4egc- i r IF 7— I 6-" Alt Phone Fax EMail : 2-c)ci - L4 L 7 - 4.1 cr Y'<'el--3SI`-3/I New Account ID: Mail Invoices to: Owner / Status Facility / Account (Circle One) (Circle One) Transfer to Active/Inactve New Owner? Aelele 19.21 MBP -Regular -Primary Location PR0520504 STOCKTON, CA 95205 Care of Y Location Code 99 - UNINCORPORATED P Bos District 002 - RUHSTALLER, LARRY APN 11707050 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION 6rVic � Account ID AR0017816 0 << Mail Invoices to Facility Account Name SHANE & DAVES TRUCK SHOP INC Account Balance as of 2/6/2013: $0.00 Fr P a`Element and Description Record ID Employee ID and Name SSN / Fed Tax ID New Owner ID -moo t- Li b 7- b6 C, �AL� rC_v cel e. 4egc- i r IF 7— I 6-" Alt Phone Fax EMail : 2-c)ci - L4 L 7 - 4.1 cr Y'<'el--3SI`-3/I New Account ID: Mail Invoices to: Owner / Status Facility / Account (Circle One) (Circle One) Transfer to Active/Inactve New Owner? Aelele 19.21 MBP -Regular -Primary Location PR0520504 EE0000000 - HAZ MAT SJC OES Inactive Y N [ D 2220 - SM HW GEN <5 TONS/YR PR0514426 EE0009488 - JEFFREY WONG Inactive Y N A D 2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOtPR0513104 EE0000000 - HAZ MAT SJC OES Inactive Y N A D 2399 - UNIFIED PROGRAM FAC STATE SURCHAR(PRO510816 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D 3122 - STORMWATER INSPECTION - AUTO SHOP PR0522991 EE0009488 - JEFFREY WONG Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andror project specific, PHS/EHD hourly charges as oc t h i c t 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 withal] applicable Ordinance C%a d Federal Laws. APPLICANT'S SIGNATURE: Date Ci 1 61 Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date / / Water System to be TRANSFERED: Payment Type Check Number REHS: COMMENTS: Amount Paid Date / / Account out: Date Received b Date (Z' � z