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9atemn - 8/19/2014 3:24:10Ph SAN J IN COUNTY ENVIRONMENTAL HEAS DEPARTMENT Report#5021 <br /> Run by 1278 Pagel <br /> Facility Information as of 8/19/2014 <br /> Record Selection Criteria: Facility ID FA0006972 <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 OW0005731 New Owner ID <br /> Owner Name TSI TRANS SYSTEM INC <br /> Owner DBA TSI TRANS-SYSTEM INC <br /> Owner Address 707 ROTH RD - V D <br /> FRENCH CAMP, CA 95231 fI P_XICIJ I t� �fio2 <br /> Home Phone Not Specified <br /> Work/Business Phone 800-541-4213 <br /> Mailing Address 7405 S Hayford Rd. <br /> Cheney, WA 99004 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0006972 10182155 <br /> Facility Name TSI TRANS SYSTEM INC <br /> Location 707 E ROTH RD <br /> FRENCH CAMP, CA 95231-9774 <br /> Phone 800-835-8894 x <br /> Mailing Address 707 ROTH RD <br /> FRENCH CAMP, CA 95231 <br /> Care of TSI TRANS SYSTEM INC <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> Bos District 001 -VILLAPUDUA Fax <br /> APN 19332008 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name STEVEN R TUCKER <br /> Title TERMINAL MANAGER <br /> Day Phone 562-810-3198 <br /> Night Phone 209-983-2288 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0009941 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name TSI TRANS SYSTEM INC (Circle One) <br /> Account Balance as of 8/19/2014: $0.00 <br /> (Circle One) <br /> Transferto ACIIveharocive <br /> ProgramlEl anent and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520395 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO612804 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PRO514363 EE0002646-THUY TRAN Active Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PR0515564 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 2361 -UST FACILITY PRO505735 EE0002646-THUY TRAN Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO507642 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO529442 EE0002646-THUY TRAN Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533136 Inactive Y N A I D <br /> 4633-TNC WATER SYSTEM WA0515553 EE0005838-ADRIENNE ELLSAESSER Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,aclmowledge that all site,anNor project specific,PHSIEHO hourly charges associated with this facility <br /> or activity will be billed to the pony identified as the OWNER on this form. I also ify Net ell operations will ado din a rdance with pplicable Ordinance Codes ander Standards antl State and'or <br /> Federal Laws. <br /> / <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 Receiv y <br /> RENS: Date_/_/_ Account out: Date / I <br /> COMMENTS: <br />