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Datemn. 3y27/2009 1:51:42PR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 715021 <br /> Run by Facility Information as of 3/27/2009 Paget <br /> Record Selection Criteria: Facility ID FA0009349 <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 OW0007349 Case Number: H03243 New Owner ID <br /> Owner Name FRED J MINER JR <br /> Owner DBA DIESEL PERFORMANCE INC <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-946-0233 <br /> Mailing Address PO BOX 8387 <br /> STOCKTON, CA 95208 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0009349 <br /> Facility Name DIESEL PERFORMANCE INC <br /> Location 2804 E FREMONT ST <br /> STOCKTON, CA 95205 <br /> Phone 209-946-0233 <br /> Mailing Address PO BOX 8387 <br /> STOCKTON, CA 95208 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 001 -GUTIERREZ, STEVE Fax <br /> APN 14343001 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 AR0016349 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name DIESEL PERFORMANCE INC (Circle One) <br /> Account Balance as of 3/27/2009: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New O,,meR Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0513781 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511637 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO519569 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0501364 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0509349 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO528343 EE0009488-JEFFREY WONG Active,Exempt Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO524079 EE5555555-Garrett Alias-Backus Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,opemtoror agent of same,acknovAedge that all site,and/or project specific,PHS/EHD hourly charges associated Win 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 andlor Standards and <br /> State andlor 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 y <br /> RENS: Date / / Account out: L,6 Date ; <br /> COMMENTS: <br /> \\eh-env\envision\reports 5021.rpt <br />