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Data run 2/8/2017 10:15:52AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Pagel <br /> Run by <br /> Facility Information as of 218/2017 <br /> Record Selection Criteria: Facility ID FA0009448 <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 OW0007448 Case Number: H04047 New Owner ID <br /> Owner Name DARTER„DONNY <br /> Owner DBA DC IMPORT SERVICE INC <br /> Owner Address 235 N MAIN ST <br /> MANTECA, CA 953364632 <br /> Home Phone 209-823-4341 <br /> Work/Business Phone 209-373-5338 <br /> Mailing Address 2a5-N--1V7g1fd-$T <br /> M -4632 Vg ll. r S rWa e- A <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009448 10182679 <br /> Facility Name DC IMPORT SERVICE INC <br /> Location 235 N MAIN ST <br /> MANTECA, CA 95336 <br /> Phone 209-823-4341 x ` 1 <br /> Mailing Address � AI# <br /> -N-#A '6� $3 Lj a ,A G .) � )q L�yd ! <br /> VC. I S?r�Nq ga ��t <br /> CA s <br /> se -8 D <br /> Care of DARTER, DONNY <br /> Location Code 04-MANTECA Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN 21722605 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> contact Name Donny Darter <br /> Title <br /> Day Phone 209-823-4341 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016448 New Account to: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name DC IMPORT SERVICE INC (Circle One) <br /> Account Balance as of 2/8/2017: $405.00 <br /> (Cirde One) <br /> Transfer to Active/Inactve <br /> ProgrannElement and Description Record ID Employee ID and Name Status New Owni Delete <br /> 1920-HMBP-Common Materials PR0519636 EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513842 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511736 EE0000000-HAZ MAT SJC OES Inactivt Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509448 EE0000000-HAZ MAT SJC DES Inactiv< Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531691 Inactiv( Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent a same,acknowledge that all site,andor 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 cerfify that all operations will be performed in accordance with all applicable Ordinance Codas ander Standards and Stale 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 /> EHD Staff: Date / / Account out: Date nZ / 91f7 <br /> COMMENTS: <br /> Invoice#: <br /> /✓Io.\�tr+� >�wf+�Si Gln.sw.S4.f t...4 r"J K” f�-E Vii yNq}\ . <br />