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Data inn 11/10/2017 9:24:39AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT RaPanusort <br /> Run by Paget <br /> Facility Information as of 11/10/2017 <br /> Record Selection Criteria: Fainly to FA0023733 <br /> Make changes corrections In RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0022070 New Owner ID <br /> Owner Name TERA INVESTMENTS INC <br /> Owner DBA SUNWEST CHEVRON <br /> OwnerAddress 4810 CHILES RD <br /> DAVIS, CA 95618 <br /> Home Phone 530-753-7129 <br /> Work/Business Phone Not Specified <br /> Mailing Address 4810 CHILES RD <br /> DAVIS, CA 95618 <br /> Care of MUNDY, DARSHAN <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0023733 <br /> Facility Name SUNWEST CHEVRON <br /> Location 2758 W KETTLEMAN LN <br /> LODI, CA 95242 <br /> Phone 916-417-8860 <br /> Mailing Address 4810 CHILES RD <br /> DAVIS, CA 95618 <br /> Care of MUNDY, DARSHAN <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MUNDY, DARSHAN <br /> Title <br /> Day Phone 916417-8860 <br /> Night Phone 530-753-7129 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> AccountlD AR0043919 New AccountlD: : <br /> Mail lnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SUNWESTCHEVRON (Circle One) <br /> Account Balance as of 11/10/2017: $0.00 <br /> (time Ona) <br /> Transfer to Activellnadve <br /> PmgtaoJElement and Description Record lD Employee lD and Name Status NewOwner? Delete <br /> 1615-RETAIL MKT 301-2000 SO FT(PREPKGD/LTD PREP) PRO542314 EE0001084-STEPHANIE RAMIREZ Active Y N A I D <br /> 2351-UST FACILITY-2481 COMPLIANT PRO541416 EE0000030-AARON HANG Active Y N A I D <br /> BILLING and COMPLIANCEACKNOWXDGEMENT; I,the undersigned owner,operatoror agent of same,acknowledge that all site.and/or purled specific,PI1SIEHD houdy charges associated wird this facility <br /> or adivty will be bill to the party Identified as the OWNER on this tn. I also cettly that all operations will be renamed In accordance with all applicable Ordinance Codes anNor Standards and State and/or <br /> Fecand 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 s Check Number Received by�� <br /> EHD Staff: ^fir Al' tl%'Ae_ ter_— Date�/1�/ '�' Account out: DetVr e r r l / D <br /> COMMENTS: IOVoiCe/l: <br /> AJc) <br />