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t :y^s.>_ t Y+ed�+vv.�1auc:ctrea`:� .FSuvvv.]ssm.���.�a_3 •Allic�::<=-`__'s_.--i:�v-:v-:n.ava;.t�:.cc.::.::_:ti:�_�xa .sysv;;av�.sss_vm-___:_:_:.�n:..v__v-��__. <br /> Daterun 8/19/2014 3:44:39PR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/19/2014 <br /> Record Selection Coterie: Facility ID FA0022540 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSNIFed Tax ID : <br /> Owner ID OW0020087 New Owner ID : <br /> Owner Name O'Reilly Auto Enterprises, L.L.C. <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 417-862-3333 <br /> Mailing Address 702 E. Bethany Home Road <br /> Phoenix, AZ 85014 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FAD022540 10586497 <br /> Facility Name O'Reilly Auto Parts#4719 <br /> Location 15079 S Harlan Rd <br /> Lathrop, CA 95330 <br /> Phone 209-234-1895 x <br /> Mailing Address 3E Company, Reg. Dept/O'Reilly Auto Parts, 3 <br /> Carlsbad, CA 92010 <br /> care of O'Reilly Auto Enterprises, L.L.C. <br /> Location Code Alt Phone <br /> BOB District Fax <br /> APN 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 AR0041232 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name O'Reilly Auto Parts#4719 (Circle One) <br /> Account Balance as of 8/19/2014: $0.00 <br /> (Circle Ona) <br /> Transfer to Activennactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0539435 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO539434 EE0002646-THUY TRAN Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the unde signed avmer,operator or agent of earns,acknowledge mat all site,anNor project specifG PHSIEHD hourly charges associated vom Mis facility <br /> or activity will be billed to the party identified as the OWNER on this farts I also certify that all operations will be pe conned in accordance with all applicable Ordinance Codes anNor Standards and state anNor <br /> Federal laws. <br /> APPLICANT'S 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 Recei by <br /> _ REHS: lAn.1 _ Date 4 Account out: Date ! / <br /> COMMENTS: <br /> 22tLL- 6*,t- IliN. •� �uv�a55�'85 <br /> Gtw JNkL tw , <br /> 69-eA 9 eA<.,li > 1 -a- 2 V%A- CES 5 . <br />