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Date run 5/2/2014 10:55:08AM SAN JOAIN COUNTY ENVIRONMENTAL HEAD DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/2/2014 <br /> Record Selection Criteria: Facility 10 FA0003824 / <br /> Make changes/corrections 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 /> + I t <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/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 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION l <br /> Contact Name _:2 :, C." v'f�o So 1 c5 <br /> Title C� 1M t ' 7 <br /> Day Phone � Q "t F+J 4' p- p 17) <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003412 New Account to: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name WASTE RECOVERY WEST INC (CirdeOne) <br /> Account Balance as of 5/2/2014: $0.00 yd}j' ®� <br /> /�� O (Circle One) <br /> Transrerto Active/Inache <br /> Program/Element and Description Record ID Employee ID and Name Stews New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO519892 EE0000000-FA42-10AT-9yCOLM W PP Z' Inactive Y NI D <br /> 2220-SM HW GEN<5 TONS/YR PRO514049 EE0000451 -STET FFE SSAo6GOI(Z JBA Ck- Inactive Y N 'V I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512109 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2301-UST STATE SURCHARGE FEE PRO507729 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2361 -UST FACILITY PR0232014 EE0001421-STACY RIVERA Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0507483 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 4720-WASTE TIRE FACILITY-MAJOR PR0535883 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and'or protect 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 cartiy that all operations will be performed in accordance with all applicable Ordinance Caches andor Standards and State arrd'or <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 Date <br /> Payment Check Number Received by <br /> Y <br /> REHS: dl 11--Z_ Date / 2— // Account out: Date / / <br /> COMMENT'S: <br /> 4- 792- 300"= �af �� � asq�� YR �a ��"s <br /> --1-(n o r r 1Lt!11- eti C / G@4- Q 4-c> �� M� /X /J too — <br />