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Date run 4/19/2004 4:01:52Pk SAN JOA'—TIN COUNTY ENVIRONMENTAL HEALT"DEPARTMENT Report x5021 <br /> Run by 4/19/2004m"" Pagel <br /> Facility Information as of 4/19/200�"' <br /> Record Selection Criteria: FacAhy ID FA0010042 <br /> Make changes/corrections in RED Ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011689 New Owner ID <br /> Owner Name LO, FENG C <br /> Owner DBA ALL TUNE AND LUBE <br /> Owner Address 2129 PISA CIR <br /> STOCKTON, CA 95206 <br /> Home Phone 209-234-6694 <br /> Work/Business Phone 209-333-6200 <br /> Mailing Address 2129 PISA CIR <br /> STOCKTON, CA 95206 <br /> Care of FENG C LO <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010042 <br /> Facility Name ALL TUNE AND LUBE <br /> Location 923 S CHEROKEE LN <br /> LODI, CA 95240 <br /> Phone 209-333-6200 <br /> Mailing Address 2129 PISA CIR <br /> STOCKTON, CA 95240 <br /> Care of FENG C LO <br /> Location Code 02-LODI APN:047-390-06 <br /> BOS District 004-SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017042 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name ALL TU BEp (Circle Ona) <br /> Account Balance as of 4/19/200 : $477.00 pY(Q kbv- . <br /> L11141a 4 (Circle One) <br /> Transfer to Active/Inacive <br /> Program/Element and Description Record IO Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PRO514141 EE0008389-DENNIS CATANYAG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512330 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO522273 Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPRO510042 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all she,and/or protect specific,PHS/EHD hourly charges associated with this <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal taws. <br /> APPLICANTS SIGNATURE: Date / I <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> lD l a4g� �� New [/wvYl✓ <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />