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P 2�. 2613 11 : 220 Sao Joaquin County No, 2914 P. 1 <br /> r - - - - -- <br /> 81e 4123/2013 11:20:56AI SAN J(le.al COUNTY ENVIRONMENTAL H9ALTk a.EPARTMENT RmcdOMl <br /> Run by Page1 <br /> Facility Informatio as of 4/23/2013 <br /> Record Seledldn CAede: Faaly ID FA0009948 <br /> r04"�'--' SS�\ Make change <br /> slcorrections in RED Ink <br /> INFORMATION CHANGE(date) <br /> \ / <br /> OWNERSHIP CHANGE(date) —��y��I.,Z. <br /> OWNER FILE INFORMATION Y` SSN/Fed Tax ID <br /> Owner ID OW0007948 Case Number: H05977 New Owner <br /> Owner Name A&A ROSSI HAY SERVICE <br /> Owner DBA <br /> Owner Address 299 N AIRPORT WAY <br /> MANTECA, CA 95336 <br /> Home Phone 209-609-6954 <br /> WorWeuslnessPhone 209-823-3965 <br /> Mailing Address PO BOX 332 <br /> MANTECA, CA 95336 <br /> Care Of A&A ROSS] HAY SERVICE A L. 0S51 nld, <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID PA0009948 10,183.053 <br /> Facility Name A&A ROSSI HAY SERVICEin&WW6 <br /> Location 299 N AIRPORT WAY <br /> MANTECA, CA 95336 <br /> Phone 209-823-3965 <br /> Mailing Address PO BOX 332 <br /> MANTECA, CA 95336 <br /> Care of <br /> Location Code 04-MANTECA Alt Phone <br /> DOS District 003-BESTOLARI DES Fax <br /> APN 19816021 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> AccountlD AR0016948 NewAccouni <br /> Mail lnv0lcesto Facility Mail lnvoioesto: Owner / Facility / Account <br /> Account Name A&A ROSSI HAY SERVICE (Dlrcle One) <br /> .Accevnt Balance as of 4123/2013: $6,500.10 <br /> 1YlDVt, �-iDr(jt"s 4D k,003gG-DZ (Circle One) <br /> Transfer to acwednaclve <br /> ProgrenOElemenl and Deempnon Rmom ID employee ID and Name slabs New Oman Delete <br /> 1921-HMBP-Regular-Primary Location PRO519980 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO514106 E20002640-THUY TRAN Active Y N A I D <br /> 2224.HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512236 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PRO509946 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2832-AST FAC 10 K-U=100 K GAL CUMULATIVEPR0515679 EED002646-THUY TRAN Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO535794 EE0007379-AMANDA BOERTIEN Act" Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURGHPR0531871 Inactive Y N A I D <br /> BIUINGand COMKMNCEACxNOWLEDGEMENT 4 me undernlpned amx,opxalorn agent Of Sams,acNnmNdge 11181.all ail;MaW projeal SPOON;P118MHO heury&,,as associated with Nle faciliy <br /> or eC1.iriywtllmbllletl 1.d ma party ldenaded as the OWNERm mis fom1. I also wNy Orelall OParagma will x performed in acooManen wNhall applicable Ordinance Codas andlor SlaMa and stale andor <br /> Federal Lewe. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: $25.00= Amount Paid �b ' Date 'T I .2�f 1(� <br /> Water System to be TRANSFERED: Amount Paid Date l� "'t'✓Dq Z <7017 <br /> O <br /> Payment Type Check Number //L/0 Receivedb -y gOO<gry �,JT <br /> REHS: 1 Date /_l_ Acoountout — Date�1 ,Z'^J �OFp�Fiy�.<iA,ry <br /> COMMENrS; I � 1.1 _ _ /1 �, ,,,,,,,,,,,, ,,�,, ' ��'ppp e 7ZNT <br /> �� � ` l � I '3 `/'/�1/— �LL4\J l rLb�J <br />