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Date run 3/22/2016 8:27:30AI� SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 Run by Pagel Facility Information as of 3/22/2016 Record Selection Criteria: Facility ID FA0010387 OWNER FILE INFORMATION Number of facilities for this owner : 1 Owner ID OW0008387 Case Number: H07975 Owner Name CHEMICAL TRANSFER CO INC Owner DBA CHEMICAL TRANSFER COMPANY (STO OwnerAddress 1033 STOKES AVE Phone STOCKTON, CA 95215 Home Phone Not Specified Work/Business Phone 209-466-3554 Mailing Address PO BOX 6036 Location Code STOCKTON, CA 95206 Care of FACILITY FILE INFORMATION Facility ID / CERS ID FA0010387 10183501 Facility Name CHEMICAL TRANSFER CO Location 1033 STOKES AVE STOCKTON, CA 95215 Phone 209-943-2639 x Mailing Address PO BOX 6036 Account STOCKTON, CA 95206 Care of JACK BISHOP Location Code 99 - UNINCORPORATED A Bos District 002 - MILLER, KATHERINE APN 14328002 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN / Fed Tax ID New Owner ID : q 17 Ain 7, Alt Phone Fax EMail : Account ID AR0017387 New Account ID: : Mail Invoices to Account Mail Invoices to: Owner / Facility / Account Account Name CHEMICAL TRANSFER CO (Circle One) Account Balance as of 3/22/2016: $0.00 (Circle One) Transfer to Active/Inactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1921 - HMBP-Regular-Primary Location PR0520286 EE0000009 - NICHOLAS LOEHRER Active Y N Y N A A tPD 2220 - SM HW GEN <5 TONS/YR PR0524679 EE0000027 - CINDY VO Active 2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512675 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO510387 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D ERSC - ELECTRONIC REPORTING STATE SURCHARGI PR0533743 Inactive Y N A I D 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 or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Program Records to be TRANSFERED: $25.00 = Water System to be TRANSFERED: Payment Type Check Number EHD Staff: 17 �ml,Cv�- Date COMMENTS: 61 aSed, 3/21 /2 of�9 Date Amount Paid Date Amount Paid Date Received by Account out: Date 3 / �✓ �/ �h�m (e,ak -a-s �n s � t� 3/ 1 /z 0f�' Invoice #: r�