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Date run 12/19/2017 2:48:35P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/19/2017 <br /> Record Selection Criteria: Facility ID FAD010209 <br /> Make changes/corrections in RED ink. 1212-1 �% <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 SSN 1 Fed Tax ID <br /> Owner ID OW0008209 Case Number: H07318 New Owner ID <br /> Owner Name TRACY DELTA SOLID WASTE MGT IN <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-835-0601 <br /> Mailing Address PO BOX 274 <br /> TRACY, CA 95378 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0010209 10183319 <br /> Facility Name TRACY DISPOSAL SVC CO INC <br /> Location 205 E THIRD ST <br /> TRACY, CA 95376 <br /> Phone 209-835-0601 <br /> Mailing Address PO BOX 274 <br /> TRACY, CA 95378 <br /> Care of MICHAEL REPETTO <br /> Location Code Alt Phone <br /> BOS District 1005 - ELLIOTT, BOB Fax <br /> APN 23512001 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 AR0017209 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility ! Account <br /> Account Name TRACY DISPOSAL SVC CO INC (3RD ST) (Circle One) <br /> Account Balance as of 12/19/2017: $0.00 <br /> (Circle One) <br /> Transfer to Acliveflnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1926-HMBP-Remote Network Location PRO512497 EE0000009-NICHOLAS LOEHRER Active Y N A Q D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO510209 EEOOOOOOO-HAZ MAT SJC OES InactivE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT_ I,the undersigned owner,operator or agent of same,acknowledge that all site,anti project specific,PHSfEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this farm. I also certify that all operations will he performed in accordance with all applicable Ordinance Codes andtor Standards and State and'or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date 1 ! <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number � Received <br /> EH17 Staff; L.:�Z- �� � �' � Date ! 2 f 22/'. Accountant: Date <br /> COMMENTS: <br /> ��� � !� S Invoice#: <br /> The bay (jgi-4 CCJSc his 5r � (� (017. <br /> dLCA 5r.� 1 <br /> jjr!(Ii, All ien1 r�v-�is Aa 4r� ee'/L <br /> OVA <br /> 6 <br />