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Date rub 7/8/2014 2:18:19PM SAN JO^11N COUNTY ENVIRONMENAL HEA1"e DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 7/8/2014 <br /> gel <br /> Record Selection Criteria: Facility ID FA0016414 <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 OW0013287 New Owner ID <br /> Owner Name OLDCASTLE APG <br /> Owner DBA OLDCASTLE-APG <br /> Owner Address 4202 GIBRALTAR CT <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-983-1609 <br /> Mailing Address 10714 POPLAR AVE <br /> FONTANA, CA 92337 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016414 10185167 <br /> Facility Name OLDCASTLE APG <br /> Location 4202 GIBRALTAR CT <br /> STOCKTON, CA 95206 <br /> Phone 209-983-1609 x0 <br /> Mailing Address 10714 POPLAR AVE <br /> FONTANA, CA 92337 <br /> Care of <br /> Location Code Alt Phone <br /> BOIS District 001 -VILLAPUDUA Fax <br /> APN 17728043 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0028875 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name OLDCASTLE APG (Circle One) <br /> Account Balance as of 7/8/2014: $0.00 <br /> (Circle One) <br /> Transferto Avive/Inachie <br /> ProgranvElement and Description Record ID Employee ID and Name Status New Owher? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO524471 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0538513 EE0001421 -STACY RIVERA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531513 Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anclor project specific.PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identKied as the OWNER on this farm 1 also certify that all operations will be performed in accordance with all applicable Ordinance Codes andior Standards and State anNor <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 Type Check Number Received by <br /> REHS: Date_/_/_ Account out: Date,_/_/_ <br /> COMMENTS: <br />