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Date run 1/10/2013 11:59:36AI SAN JIN COUNTY ENVIRONMENTAL HE DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1/1012013 <br /> Record Selection Criteria: Facility 10 FA0006195 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0004938 New Owner ID <br /> Owner Name MEPCO LABEL SYSTEMS <br /> Owner DBA <br /> Owner Address 1313 S STOCKTON ST <br /> LODI, CA 95240 <br /> Home Phone 209406-6170 <br /> Work/Business Phone 209-946-0201 <br /> Mailing Address PO BOX 932 <br /> STOCKTON, CA 95201 <br /> Care of TRACY, PHILIP <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006195 <br /> Facility Name MEPCO LABEL SYSTEMS <br /> Location 1313 S STOCKTON ST <br /> LODI, CA 95240 <br /> Phone 209-946-0201 <br /> Mailing Address-P-BeX-952— /3 i3 5%• <br /> ST Ge r Crq 9Sz 5to <br /> Careof TRACY, PHILIP <br /> Location Code 02- LODI Alt Phone <br /> BOIS District 004 -VOGEL, KEN Fax <br /> APN 04705013 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 AR0007297 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name MEPCO LABEL SYSTEMS (Circle One) <br /> Account Balance as of 1/10/2013: $0.00 <br /> (Circle One) <br /> Transfer to ActiveMactve <br /> r re mant and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 - BP-Regular-Primary Location PR0520564 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> \,99ZGA1SM HW GEN<5 TONSNR PRO514466 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0513230 EEO00000o-HAZ MAT SJC OES Inactive Y N A I D <br /> 2229-GEN 50<250 TONS PERMIT PR0506008 EE0001422-ARIS CACAPIT Inactive Y N A I D <br /> 2231 -HAZARDOUS WASTE PER FACILITY PR0527699 EE0001422-ARIS CACAPIT Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0504420 EE0001422-ARIS CACAPIT Inactive Y N A 1 D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PRO507618 EE0001422-ARIS CACAPIT Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PR0534320 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,PHSIEHD hourly charges associated with this facility <br /> or activity,will be billed to the perry identified as the OWNER on this form I also certify Mat all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and Stale ander <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date _II_ <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 Re e y <br /> REHS /"-- — -- Date I Account out: - Date 71.3D I /3 <br /> COMMFIKS: <br />