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Date run 1011912017 12:02:11F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 45021 <br /> Run by Pagel <br /> Facility Information as of 10/19/2017 <br /> Record Selection Criteria Facility ID FA0010933 <br /> Make changesicorrections 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 OW0008933 Case Number: H08999 New Owner ID <br /> Owner Name OSORIO, HECTOR <br /> Owner DBA CONTINENTAL MUFFLER <br /> Owner Address 230 E LODI <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-368-1360 <br /> Mailing Address 230 E LODI AVE <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010933 10183945 <br /> Facility Name CONTINENTAL MUFFLER <br /> Location 230 E LODI AVE <br /> LODI, CA 95240 <br /> Phone 209-368-1360 x0 <br /> Mailing Address 230 E LODI AVE <br /> LODI, CA 95240 <br /> Care of HECTOR OSORIO <br /> Location Code 02- LODI Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 04719129 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Hector Osorio <br /> Title Owner <br /> Day Phone 209-368-1360 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017933 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name OSORIO, HECTOR wKry o (Circle One) <br /> Account Balance as of 10/19/2017: $438-B9� <br /> (Circle One) <br /> Transferto Active4nactve <br /> ProgramlEiement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0520868 EE0008709-JAMIE LIMA Active Y N A � D <br /> 2220-SM HW GEN<5 TONSIYR PRO514460 EE9999998-ONE VACANTI Active Y N A lam' D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513221 EE0000000-HAZ MAT SJC OES InaCkIME Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0510933 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE PR0532307 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHS/EHD hourly charges associated with this facility <br /> 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 Ordinance Codes andlor Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date ! t <br /> Water System to be TRANSFERED: Amount Paid Date 1 ! <br /> Payment Tyne Check Number Received b <br /> EHD Staff: Date 1 /�� Account out: Date /0/ 1 1-7 <br /> i3us R' Invoice <br /> w ria <br /> YYui ►'l a4 a rill <br />