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Date run 6/29/2016 8:29:36AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 6/29/2016 <br />Record Selection Criteria: Facility ID FA0023537 <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 <br />Owner ID OW0021826 <br />Owner Name JH Motorsports Inc <br />Owner DBA <br />Owner Address <br />Home Phone Not Specified <br />Work/Business Phone 209-968-0077 <br />Mailing Address 14150 S Harlan Rd <br />Lathrop, CA 95330 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0023537 10672240 <br />Facility Name <br />JH Motorsports Inc <br />Location <br />14150 S Harlan Rd <br />Lathrop, CA 95330 <br />Phone <br />209469-1513 x <br />Mailing Address <br />14150 S Harlan Rd <br />Lathrop, CA 95330 <br />Care of <br />Jason Harbinson <br />Location Code <br />BOS District <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0043432 <br />Mail Invoices to Account <br />Account Name Dru Yoder <br />Account Balance as of 6/29/2016: $0.00 <br />Make changestcorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail: <br />Mail Invoices to <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1921 - HMBP-Regular-Primary Location PR0541105 EE0000010 - PETER LOMBARDI Active Y N A I D <br />2220 - SM HW GEN <5 TONS/YR PR0541104 EE0000015 - TIMOTHY ENGLE 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 facility or <br />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 and/or Standards and State and/or Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: * $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment TypeCheck Number Received by <br />EHD Staff: w Date / /�� Account out: Date / %� / �Y <br />COMMENTS:-2g��//� <br />Invoice #: —, )- <br />� (/+ � %Z 7 �KO i Gy�Q( GA�fnG, .� �r n � tFi�., _►'1'I�" � ��13 L,0- s {e <br />