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Daterun . 3/3/2015 1:07:20PM SAN JOGJIN COUNTY ENVIRONMENTAL HEAT DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/3/2015 <br /> Record Selection Criteria: Facility ID FA0005180 <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: 2 SSN/Fed Tax ID <br /> Owner ID OW0013211 New Owner ID <br /> Owner Name VERNON TRANSPORTATION <br /> Owner DBA VERNON TRANSPORTATION <br /> Owner Address 2313 W NAVY DR <br /> STOCKTON, CA 95206 <br /> Home Phone 209-546-0171 <br /> Work/Business Phone 209-546-0171 <br /> Mailing Address PO BOX 31450 <br /> STOCKTON, CA 95213 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0005180 10181761 <br /> Facility Name VERNON TRANSPORTATION <br /> Location 2313 W NAVY DR <br /> STOCKTON, CA 95206 <br /> Phone 209-546-0171 <br /> Mailing Address PO BOX 31450 An a r <br /> STOCKTON, CA 95213 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 16332005 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 AR0005628 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name VERNON TRANSPORTATION (Cirde One) <br /> Account Balance as of 3/3/2015: $335.00 <br /> (Circe One) <br /> Transterto VActave <br /> Progra"Element and Description Record ID Employee ID and Name 5 tus New Owner?1921 -HMBP-Regular-Primary Location PRO628778 EE0009817-ROBERT LOPEZ Y N A2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0501664 EE0000418-MICHAEL KITH active Y N A <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533058 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,aanowledge that all site,anclor project specific,PHSIEHD hourly charges associated with this facility or 4 <br /> be billed to the party identgied as the OWNER on this form 1 also certify that all operations will be performed in accordance with all applicable Ordinance Codes anclor Standards and State anclor 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 Ty —� Check Number Received b <br /> REHS: �m � Date 3 / c3 ! y-� Account out: _ Date <br /> � <br /> COMMENTS: r <br /> � IxCLC- � � #t� 2 � � Ad <br />