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Date run 9/26/2016 12:19:42PI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 9/26/2016 <br />Record Selection Criteria: Facility ID FA0012376 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID OW0009602 <br />Owner Name <br />VINTAGE AIRCRAFT <br />Owner DBA <br />VINTAGE AIRCRAFT <br />OwnerAddress <br />7432 S C E DIXON <br />STOCKTON, CA 95206 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-982-0273 <br />Mailing Address <br />7432 C E DIXON ST <br />Care of <br />STOCKTON, CA 95206 <br />Care of <br />99 - UNINCORPORATED A <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0012376 10184207 <br />Facility Name <br />VINTAGE AIRCRAFT <br />Location <br />7432 S C E DIXON WAY <br />STOCKTON, CA 95206 <br />Phone <br />209-982-0273 x <br />Mailing Address <br />7432 C E DIXON ST <br />STOCKTON, CA 95206 <br />Care of <br />Taigh Ramey <br />Location Code <br />99 - UNINCORPORATED A <br />Bos District <br />001 - VILLAPUDUA, CARLOS <br />APN <br />17726034 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0020230 <br />Mail Invoices to Account <br />Account Name VINTAGEAIRCRAFT <br />Account Balance as of 9/26/2016: $0.00 <br />Program en/Elemriptiln C� <br />192 MBP -Common Materials <br />2220 - SM HW GEN <5 TONS/YR <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FI <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) -7 <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />T <br />New Account ID: <br />Mail Invoices to: <br />Owner / <br />Facility / <br />Account <br />(Circle One) <br />(Circle One) <br />Transfer to <br />Active/Inactve <br />Record ID <br />Employee ID and Name <br />Status <br />New Owner? <br />Delete <br />PR0525754 <br />EE0009817 - ROBERT LOPEZ <br />Active <br />Y N <br />A <br />I D <br />PR0534882 <br />EE9999998 - ONE VACANTI <br />Active <br />Y N <br />A <br />I D <br />PR0515912 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y N <br />A <br />I D <br />PR0515913 <br />EE0009999 - SITE UNASSIGNED <br />Inactive <br />Y N <br />A <br />I D <br />PR0531390 <br />InactivE <br />Y N <br />A <br />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 <br />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/or <br />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 Type Check Number Received/bye p / <br />EHD Staff: 'e— z— Date / 2 / Account out: b J Date I A0 / Y <br />COMMENTS: <br />Ir1V01Ce #: <br />