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Date run 1/15/2014 9:56:31Ah SAN JOIN COUNTY ENVIRONMENTAL HEAIWEPARTMENT Report#5021 <br /> Run,by. Pagel <br /> • Facility Information as of 1/15/2014 <br /> Record Selection Criteria: Facility ID FA0005608 <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 OW0004433 New Owner ID <br /> Owner Name HD Supply Waterworks, LTD <br /> Owner DBA LLC <br /> Owner Address 1625 STOCKTON ST <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 770-852-9000 <br /> Mailing Address 3100 Cumberland Blvd., MS-1226 <br /> Atlanta, GA 30339 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0005608 10145903 <br /> Facility Name HD Supply Waterworks, Ltd. <br /> Location 1625 S Stockton St <br /> Lodi, CA 95240 <br /> Phone 209-333-7698 x <br /> Mailing Address 1625 S Stockton St <br /> Lodi, CA 95240 <br /> Care of John Buck <br /> Location Code 02- LODI Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 062-050-11 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 AR0006241 New Account ID: <br /> Mail Invoices to fir' 7 Mail Invoices to: Owner / Facility / Account <br /> Account Name HD Supply Waterworks, LTD (Circle One) <br /> Account Balance as of 1/15/2014: $0.00 <br /> (Circle One) <br /> Transfer to Aclivennii <br /> o aMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 - MBP-Regular-Primary Location PRO520808 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 222g0/ M HW GEN<5 TONS/YR PRO513684 EE0001422-ARIS CACAPIT Active Y N I D <br /> 224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511462 EE0000000-HAZ MAT SJC DES Inactivc Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0502895 EE0000451 -STEVE SASSON Inactivc Y N A I D <br /> 2399-UNIFIED PROGRAM FAG STATE SURCHARGE F PRO509174 EE0000000-HAZ MAT SJC GIES 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 party identified as the OWNER on this forth I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State anclor <br /> 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 Type Check Number Received by I, <br /> REHS: tA/.NG, Date�/ I S /�_ Account out: Date <br /> COMMENTS: <br /> AC-ttvA-%_q ('I 7-t 4- V cc-Rs , New o� <br />