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Date run 2/11/2014 12:46:35PI SAN JO*IN COUNTY ENVIRONMENTAL HEALWEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 2/11/2014 <br /> Record Selection Criteria: Facility ID FA0012408 <br /> Make changesicorrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0009621 New Owner ID <br /> Owner Name BRAGG COMPANIES <br /> Owner DBA BRAGG COMPANIES <br /> owner Address 6251 PARAMOUNT BLVD <br /> LONG BEACH, CA 90805 <br /> Home Phone 800-944-5623 <br /> Work/Business Phone Not Specified <br /> Mailing Address 6251 PARAMOUNT BLVD <br /> LONG BEACH, CA 90805 <br /> Care of KUPFER, OWEN <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0012408 <br /> Facility Name HEAVY TRANSPORT INC <br /> Location 2420 E EIGHT MILE RD <br /> STOCKTON, CA 95210 <br /> Phone 800-327-8694 <br /> Mailing Address PO BOX 8389 <br /> STOCKTON, CA 95208 <br /> care of SABIN, LORIN <br /> Location Code 99-UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 12002014 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 AR0026265 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name BRAGG COMPANIES (Circle One) <br /> Account Balance as of 2/11/2014: $0.00 <br /> (Circle Ona) <br /> Transfer to Activellnaclve <br /> ProgramlElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520838 EE0008709-JAMIE DE LA ROSA Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0615985 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO515987 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO515989 EE0009999-SITE UNASSIGNED Inactive Y N A I D <br /> '254Q-AST EXEMPT FAC < 1,320 GAL PR0516623 EE0004636-GARRETT BACKUS Inactive Y N I D <br /> 740-WASTE TIRE SITE-EXEMPT PRO524828 EE0002622-BENJAMIN ESCOTTO Active Y N A 1 D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533102 Inactive Y N I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT, I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associate vnm thisfacility <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 andror Standards and State andfor <br /> Federal Laws. V//V,r','///'ot(�®(.0 <br /> APPLICANT'S SIGNATURE: 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 Receiv d <br /> REHS: '53/� p® Date 7�q/ 1 / �7Account out: / Date -1tP,{J �yG <br /> COMMENTS: KCQ <br /> 7 Y\F��j S 2-3j s:J C� /'Ti// ) P{F© b D Lt (//' 1l l�`�'JC7.�/ V <br /> 27, <br /> v.i:aJi tea. '9'. 6-A F7T)'?A�2-1-S. -,76 37,) <br />