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Date run 5/2/2014 10:55:08AM SAN JO! TIN COUNTY ENVIRONMENTAL HEAL -DEPARTMENT Report#5021 <br /> Run by �1100" `a w Pagel <br /> Facility Information as of 5/2/2014 <br /> Record Selection Criteria: Facility ID FA0003824 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0002833 New Owner ID <br /> Owner Name WASTE RECOVERY WEST INC <br /> Owner DBA WASTE RECOVERY WEST INC <br /> Owner Address 4554 S EL DORADO ST <br /> STOCKTON, CA 95206 <br /> Home Phone 916-813-4704 <br /> Work/Business Phone Not Specified <br /> Mailing Address 4554 S EL DORADO ST <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0003824 <br /> Facility Name WASTE RECOVERY WEST INC <br /> Location 4554 S EL DORADO ST <br /> STOCKTON, CA 95206 <br /> Phone 916-813-4704 <br /> Mailing Address 4554 S EL DORADO ST <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> Bos District 001 -VILLAPUDUA Fax <br /> APN 19302044 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name 12 c r. AO J'o c, <br /> Title ('T W\ , <br /> Day Phone �2_Q -L 133 47 - p-7 O 17) <br /> Night Phone y <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003412 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name WASTE RECOVERY WEST INC (coaaOne) <br /> Account Balance as of 5/2/2014: $0.00 `QItL' Z� C <br /> Cede One) <br /> Tranererto Adiveflnacive <br /> Program/Element and Desorption Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO519892 EE0000000-HAZ-MAT3Je-9E3 �O��Z Inactive Y N 1 D <br /> 2220-SM HW GEN<5 TONSNR PRO514049 EE0000451 - Inactive Y N I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512109 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PR0507729 EE0000451 -STEVE SASSON Inactive Y N A 1 D <br /> 2361 -UST FACILITY PR0232014 EE0001421 -STACY RIVERA Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO507483 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 4720-WASTE TIRE FACILITY-MAJOR PRO535883 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,ackmowleoge that all site,andor project specific,PHSEHD hourly charges associatetl with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also candy that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid to <br /> Payment T Check Number Recely <br /> REHS: ��R-2_-- Date / 2-- / / Account out: Date <br /> COMMENTS: <br /> a s I Cir 5�9 Z- 171, �s 300I�= �v �� as�� y Q4 iriiwics <br />