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Date run 7/1/2013 4:17:58PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/112013 <br /> Record Selection Criteria: Facility 10 FA0014331 <br /> Make chs INFO or INFORMATION <br /> In RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011382 Case Number: H03965 New Owner ID <br /> Owner Name TIRES PLUS <br /> Owner DBA MORGAN TIRE&AUTO <br /> Owner Address 802 S FIRST ST <br /> SAN JOSE, CA 95110 <br /> Home Phone Not Specified <br /> Work/Business Phone 800-269-4424 <br /> Mailing Address 2021 SUNNYDALE BLVD <br /> CLEARWATER, FL 33765 <br /> Care of ELIANNE KEMPSELURISK <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0014331 10,184,607 <br /> Facility Name WHEEL WORKS <br /> Location 420 W LODI AVE <br /> LODI, CA 95240 <br /> Phone 209-339-9500 <br /> Mailing Address 2021 SUNNYDALE BLVD <br /> CLEARWATER, FL 33765 <br /> Care of ELIANNE KEMPSELURISK <br /> Location Code 02- LODI Alt Phone <br /> BOB District 004-VOGEL, KEN Fax <br /> APN 04502047 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 AR0024355 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name TIRES PLUS (Circle One) <br /> Account Balance as of 7/1/2013: $0.00 <br /> (tires one) <br /> Transfer to AdNe/lnaclve <br /> Progra"Elemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO521212 EE0008709-JAMIE DE LA ROSA Active Y N A O D <br /> 2227-GEN 5<25 TONS PERMIT PRO623179 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO519163 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0522552 EE0002620-ALFONSO ARAMBULA Active Y N A Q D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534349 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acimowledge that all site,andfor 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 tardy that all operations will be Performed in accordance with all applicable Ordinance Codes andfor Standards and State and'or <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 T/�y/�pe Check Number Received by <br /> REHS: N�idf Date -,7 /12L/_J�._ Accountout: Date ? J / <br /> COMMENTS: <br /> ���u0ch 1,6�3-ZO�-27 <br />