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Date run 5/6/2016 2:43:43PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 5/6/2016 <br />Record Selection Criteria: Facility ID FA0015498 <br />OWNER FILE INFORMATION Number of facilities for this owner : 1 <br />Owner ID <br />OW0012451 <br />Owner Name <br />Charles Proctor <br />Owner DBA <br />TRINKLE AG FLYING INC <br />Owner Address <br />25001 KASSON RD <br />Mailing Address <br />TRACY, CA 95304 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-835-2838 <br />Mailing Address <br />25001 KASSON RD <br />BOS District <br />TRACY, CA 95304 <br />Care of <br />23918005 <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0015498 10184967 <br />Facility Name <br />TRINKLE AG FLYING INC <br />Location <br />25001 KASSON RD <br />TRACY, CA 95304 <br />Phone <br />209-835-2838 x0 <br />Mailing Address <br />27460 KASSON RD <br />TRACY, CA 95304-8001 <br />Care of <br />Trinkle Ag Flying Inc. <br />Location Code <br />BOS District <br />APN <br />23918005 <br />Make changestcorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID <br />44 <br />Alt Phone <br />Fax <br />EMail : <br />EMERGENCY NOTIFICATION CONTACT INFORMATION p !�� <br />Contact Name \\`� ` ��}' <br />Title A\ -9(•Y('}• <br />Day Phone <br />Night Phone �Y <br />ACCOUNTS RECEIVABLE FILE INFORMATION��� <br />C; <br />Account ID � / }�\� <br />AR0026740 , New Account ID: <br />Mail Invoices to Account , Mail Invoices to: Owner / Facility / Account <br />Account Name TRINKLEAG FLYING INC OJ�/� (Circle One) <br />Account Balance as of 5/6/2016: $758.00 `C <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1921 - HMBP-Regular-Primary Location PR0522727 EE0000010 - PETER LOMBARDI Active Y N AD <br />2220 - SM HW GEN <5 TONS/YR PR0538492 EE0001459 -VICKI MCCARTNEY Active Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGE PR0531896 Inactive 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 project 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 certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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 />EHD Staff: MaCDi r -I n e Date 3" / C / (o Account out: 111�2 Date S l 10 l� <br />COMMENTS: 1 <br />)� �IGaZ�r t/� /lnrgd�Z CL C{'tP,Yf'ie_odS "v e Invoice#: <br />2 e n -i rQ rn o,� 2�t ram -4h e ra el -e' I� e w e r.� n-� si-a+-8, <br />7Dee'm,bey oI� <br />1 rinKl e. A G C0/+e- ►ti r- <br />