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Date run 9/23/2014 8:21:29AR SAN JO�Iei COUNTY ENVIRONMENTAL HEAT .DEPARTMENT RaPon#5o21 <br />RJ <br />by Mr Pagel <br />Facility Information as of 9/23/2014 <br />Record Selection Criteria: Fisuldy ID FA0017757 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0014584 <br />Owner Name <br />RIOS, RICHARD <br />Owner DBA <br />1905 E FREMONT ST <br />Owner Address <br />PO BOX 492 ST <br />Phone <br />STOCKTON, CA 95201 <br />Home Phone <br />209-462-3101 <br />Work/Business Phone <br />209-463-0957 <br />Mailing Address <br />PO BOX 492 <br />Location Code <br />STOCKTON, CA 95201 <br />Care of <br />RIOS, RICHARD <br />FACILITY FILE INFORMATION <br />Facility lD/CERS ID <br />FA0017757 10186679 <br />Facility Name <br />RIOS BODY SHOP <br />Location <br />1905 E FREMONT ST <br />STOCKTON, CA 95205 <br />Phone <br />209-463-0957 <br />Mailing Address <br />PO BOX 492 <br />STOCKTON, CA 95201 <br />Care of <br />RIOS, RICHARD <br />Location Code <br />01-STOCKTON <br />BOIS District <br />001 - VILLAPUDUA <br />APN <br />14109025 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0030977 <br />Mail Invoices to Owner <br />Account Name RIOS, RICHARD <br />Account Balance as of 9/23/2014: $0.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) 'It-, <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail: <br />New Account ID: <br />Mail Invoices to: Owner / Facility / Account <br />(Cirde One) <br />(Circle One) <br />Transfer to Activellnedve <br />ProsamlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br />1921 - HMBP-Regular-Primary Location PRO526236 EE0000006- HAZA SAEED Active Y N AI D <br />2220 - SM HW GEN <5 TONS/YR PRO539102 EE0009488 - JEFFREY WONG Active Y N A D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PRO533620 Inactive Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersignetl owner, operator or agent of same, scknowladge that all site, anclor project specific, PHSEHD hourly charges associated with this facility <br />or activity will be billed to me party identified as the OWNER on this form. 1 also certify that all operations will t s performed in accordance with all applicable Ordinance Codes ander Standards and State ands <br />Federal Laws. <br />APPLICANTS SIGNATURE: 5- C L-�-- Date VG /�/ \tel <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 —Re ce' y <br />REHS: �+ Date _/ {� /_Account out: Date <br />Q <br />COMMENTS: <br />711 \z �l�s�cale c c,�� e o� rctSls� ei�x���.o i� b ns�ec� <br />0't\ \o I \ 3 f VA, <br />