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Ds'erun 6/20/2013 11:17:07AI SAN JC 'JIN COUNTY ENVIRONMENTAL HEA 1 DEPARTMENT Report#5021 <br /> Rut by "1111111111'r Pagel <br /> Facility Information as of 6/20/2013 <br /> Record Selection Crilerla. Facility ID FA0010901 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSNI Fed Tax ID <br /> Owner ID OW0008901 New Owner ID : <br /> Owner Name SOUTHWEST TRADERS INC <br /> Owner DBA SOUTHWEST TRADERS INC <br /> Owner Address 4747 S FRONTIER WAY <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone 951-676-8448 <br /> Mailing Address 4747 S FRONTIER WAY <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010901 10,183,921 <br /> Facility Name SOUTHWEST TRADERS INC <br /> Location 4747 N FRONTIER WAY A _ <br /> STOCKTON, CA 95215 <br /> Phone 209-462-1607 x0 <br /> Mailing Address 4747 S FRONTIER WAY <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 17925031 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 AR0017901 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility 1 Account <br /> Account Name SOUTHWEST TRADERS INC (Circle Ore) <br /> Account Balance as of 612012013: $0.00 <br /> (Circle One) <br /> Transfer to Aclivellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0521654 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513189 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510901 EE0o00000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532810 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,,operator or agent of same,acknowledge that all site,andfor proyect specific,PHSIEHD 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 Stale andror <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 I <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: Amount Paid Date / 1 <br /> Payment Type Check Number Received by <br /> REHS: Date r r Account out: Date 1 r <br /> COMMENTS- <br />