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Date ran 12/22/2014 10:49:17/ SAN JOt.1IN COUNTY ENVIRONMENTAL HEAL`1 DEPARTMENT Pagel*5021 <br /> Ron by Facility Information as of 12/22/2014 <br /> Record Selection Criteria: Facility ID FA0010041 <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 OW0008041 Case Number: H06315 New Owner ID <br /> Owner Name ALGER, BRENT <br /> Owner DBA AG-AIR INC <br /> Owner Address 5420 E DODDS RD <br /> OAKDALE, CA 95361 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-988-2567 <br /> Mailing Address 5420 E DODDS RD <br /> OAKDALE, CA 95361 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010041 10183153 <br /> Facility Name AG AIR INC <br /> Location 18417 E HWY 4 <br /> STOCKTON, CA 95215 <br /> Phone 209-465-5818 x <br /> Mailing Address 5420 E DODDS RD <br /> OAKDALE, CA 95361 <br /> care of Brent Alger <br /> Location code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 18325012 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 AR0017041 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name ALGER, BRENT (ClydeOne) <br /> Account Balance as of 12/22/2014: $0.00 <br /> (cirde oma) <br /> Transfer to Active/Inai <br /> PrograrNElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0521206 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2221 -USED OIL ONLY-<5 TONS/YR PRO523689 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512329 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510041 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0529721 EE0009488-JEFFREY WONG Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534455 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to Ne party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws. <br /> APPLICANTS 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 Received by <br /> REHS: Date_/_/_ Account out: Date <br /> COMMENTS: <br />