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Date run 6/29/2016 829:36AK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/29/2016 <br /> Record Seiection Cl Facility ID FA0023537 <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 OW0021826 New Owner ID <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 IDICERS ID FA0023537 10672240 <br /> Facllity Name JH Motorsports Inc <br /> Location 14150 S Harlan Rd <br /> Lathrop, CA 95330 <br /> Phone 209-469-1513 x <br /> Mailing Address 14150 S Harlan Rd <br /> Lathrop, CA 95330 _ <br /> Care of Jason Harbinson <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 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 AR0043432 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility / Account <br /> Account Name Dru Yoder (Circle One) <br /> Account Balance as of 6/29/2016: $1 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0541105 EE0000010-PETER LOMBARDI Active Y N A I D <br /> 2220-SM HW GEN<5 TONSJYR 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,Pl-1 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 Slate andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 I <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 J <br /> Water System to be TRANSFERED: Amount Paid Date / 1 <br /> Payment Type Check Number Received by <br /> EHD Staff: Date 1 ;X11� Account out: Date 1 �� I /4' <br /> COMMENTS: <br /> Invoice#: <br /> 4e - <br /> f7fr <br /> &0[2 7 <br />