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Date run 6/5/2007 10:38:38AM SAN d UIN COUNTY ENVIRONMENTAL HE DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 6/5/20 7 <br /> Record Seisction Criteria: Facility iD FAOOD4959 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) D <br /> Owner ID OW0014626 New Owner ID <br /> Owner Name MARTIN, TODD A <br /> Owner DBA <br /> Owner Address 3472 ENTERPRISE AVE <br /> HAYWARD, CA 94545 <br /> Home Phone 510-575-6041 <br /> Work/Business Phone 209-943-9004 <br /> Mailing Address 3472 ENTERPRISE AVE <br /> HAYWARD, CA 94545 <br /> Care of MARTIN, TODD A <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004959 add <br /> Facility Name CHARTER WAY AUTO DISMANTLERS J y ' ! <br /> Location 930 E CHARTER WAY - <br /> STOCKTON, CA 95206 QS n0 WC� 2 t��5 t�-`�I' <br /> Phone 209-943-9004 (1,✓ <br /> Mailing Address 1919 E CHARTER WAY STE B <br /> STOCKTON, CA 95205 <br /> Care of MARTIN, TODD A <br /> Location Code 01 -STOCKTON APN:1671830315 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> 'ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005401 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: l Owner / Facility / Account <br /> Account Name CHARTERAY A TO DISMANTLERS (Circle One) <br /> Account Balance as of 61512007: 0, <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner'? Delete <br /> 2217-APPLIANCE RECYCLER PRO521509 EE0008317-RAYMOND VON FLUE Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO517682 EE0008317-RAYMOND VON FLUE Active Y N A 1 D <br /> 2220-SM HW GEN<5 TONSNR PRO521746 EE0008317-RAYMOND VON FLUE Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO517681 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO521105 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1184)-obsolete PR0500994 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPR0517683 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523946 EE0000060-JENNIFER FRASE Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSIEHD 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 operatlons will be performed in accordance with all applicable Ordinate Codes andlor Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! / <br /> Program Records to be TRANSFEkED: "$20.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: "$372.00= Amount Paid Date / ! <br /> Payment Tye Check Number Rece' d by <br /> REHS: Date 1 1 Account out: P9— Date I s 1 6 <br /> COMMENTS: <br /> L7V- 7 <br /> Vphs-ehsgl-ntlappMenvis ion slreports15021.rpt <br />