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Date run 9/12/2016 1:45:58PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 Run by Facility Information as of 9/12/2016 Pagel Record Selection Criteria: Facility ID FA0009502 Make changes/corrections in RED ink. INFORMATION CHANGE(date) OWNERSHIP CHANGE(date) OWNER FILE INFORMATION Number of facilities for this owner: 2 SSN/Fed Tax ID Owner ID OW0007502 Case Number: H04587 New Owner ID Owner Name WOODBRIDGE SANITARY DIST Owner DBA WOODBRIDGE SANITARY DISTRICT OwnerAddress 19720 N BENEDICT DR WOODBRIDGE, CA 95258 Home Phone Not Specified Work/Business Phone 209-368-0900 Mailing Address 19720 N BENEDICT DR WOODBRIDGE, CA 95258-9052 Care of FACILITY FILE INFORMATION Facility ID/CERS ID FA0009502 10182735 Facility Name WOODBRIDGE SANITARY DIST Location 19720 N BENEDICT OR WOODBRIDGE, CA 95258 Phone 209-368-0900 x Mailing Address 19720 N BENEDICT DR WOODBRIDGE, CA 95258-9052 Care of Woodbridge Sanitary District Location Code 99 - UNINCORPORATED A Alt Phone SOS District 004 -WINN, CHARLES Fax APN 01521060 EMail: EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0016502 New Account ID: Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account Account Name WOODBRIDGE SANITARY DIST (Circle One) Account Balance as of 9/12/2016: $0.00 (Circle One) P�gnitl Element and DescriptionRewrd ID Employee ID and Name Status Transferto ActheAnaclve New Owner? Delete �HMBP-Regular-Primary Location PRO520176 EE0008709-JAMIE LIMA Active Y N A I D 2232-HAZARDOUS WASTE CA FACILITY PR0511790 EE0000000-HAZ MAT SJC OES Inactive Y N A I D 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509502 EE0000000-HAZ MAT SJC OES Inactive Y N A I D 2840-AST EXEMPT FAC <1,320 GAL PRO628979 EE0001422-ARTS VELOSO Inactive Y N A 1 D ERSC-ELECTRONIC REPORTING STATE SURCHARGE PRO531655 Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project speck,PHSIEHD hourly charges associated with this 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 Ordinance Codes and'or Standards and State and'cr Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: •$25.00= Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received EHD Staff: Date----L—L— Account out: Date_ 91414, COMMENTS: C/WC04 Ijy j0 1 I /WV4 1 6'LA ^ Invoice#