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Date run 4/6/2010 1:17:30PM Report#5021 <br /> SAN J IN COUNTY ENVIRONMENTAL HEA DEPARTMENT <br /> Run by Pagel <br /> Facility Information as of 4/6/2010 <br /> Record Selection Criteria: Facility ID FA0014421 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011463 New Owner ID <br /> Owner Name ROBERT J GARCIA <br /> Owner DBA BOB'S GERMAN AUTO REPAIR <br /> Owner Address 2230 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-465-2521 <br /> Mailing Address 2230 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014421 <br /> Facility Name BOBS GERMAN AUTO REPAIR <br /> Location 2230 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Phone 209-465-2521 <br /> Mailing Address 2230 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 11711036 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name GARCIA, ROBERT J <br /> Title <br /> Day Phone 209-465-2521 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024501 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name ROBERT J GARCIA (Circle One) <br /> Account Balance as of 4/6/2010: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0524615 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0519279 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 3122-STORMWATER INSPECTION-AUTO SHOP PR0529449 EE0009488-JEFFREY WONG Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO531707 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: $372.00= Amount Paid Date ! / <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\e h-env\envision\reports\5021.rpt <br />