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DW tun 113012013 4:08:12131li SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repon45021 <br /> Run by Pagel <br /> Facility Information as of 1/30/2013 <br /> Record Selection Criteria: Facility ID FAC013665 <br /> Make changes/corrections in RED ink. ^ <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSNIFed Tax ID : D3.L95-1.5 <br /> Owner ID OW0010765 New Owner M <br /> Owner Name INTEGRATED TRUSS SYSTEMS INC 5A+E <br /> Owner DBA VILLATRUSS N <br /> OwnerAddress 1320 E VICTOR G ry l C l4 E RO tLF E 1 AN G, Sus f F {� <br /> LODI, CA 95240 Liz CA 95a-:_4o <br /> Home Phone Not Specified Slat <br /> Work/BusinessPhone 209-333.7117 :5A4_AE <br /> Malling Address 1220 E VICTOR RD 051 (J • C-1�EPOY t.E lAt�1 F.r SJS i <br /> LODI, CA 95240 LODa , C \ R,5Z4Q <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013655 fAM IF <br /> Facility Name VILLA TRUSS g pr�A ' <br /> Location 1320 EVICTOR 3 A-tA C — <br /> LODI, CA 95240 S A-N G <br /> Phone 209-333-7117 x0 <,AM <br /> Mailing Address 1220 EVICTOR RD l trE R,0 4- E P1 <br /> LODI, CA 95240 <br /> Care of <br /> Location Code 02-LODI All Phone <br /> BOB District 004-VOGEL, KEN Fax — <br /> APN 04932008 EMail: iv L�®�)'t��}CUSS • C A .v! <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name L <br /> Title Piz E S T-ij NT 1 <br /> Day Phone a09 -!49-63'79 <br /> Night Phone 91 t'- $ -0-101 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022812 New Account ID: <br /> Mail lnvolcesto Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name INTEGRATED TRUSS SYSTEMS INC (Ciraeone) <br /> Account Balance as of 1/3012013: $0.00 <br /> (Greta one) <br /> Transfer to AcevellnaoNe <br /> Pr roMElem�t and Description Record 10 Employee ID ON Nam Status New Owner? Delete <br /> 1920- MBP-Common Materials PR0520946 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> Q22*,--'HAZ MAT BUSINESS PLAN AUTHORILITIOIPR0518021 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0518020 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PR0533667 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACIWOWLEOGEME 1.Me,rderelgnadawnar,operator or spent of awe.aknowledpa that all site,andor project speeifio,PNSIERD hwdy ohe,pes associated with this facility <br /> or actIvitywill beblilldt.thepa,ty idernifledas M ER on Mie form lEla-caddy that all Operations w:1 be performed in acoorderwe with all applicable Ordinance Cocoa andor Standards and State angor <br /> Federal Lexis <br /> ��.ZQ13 <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFER '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid <br /> Payment Type Check Number Received by <br /> REHS: rt-1- A,( 76Y Date d 1 1L_ Account out: _ Date <br /> COMMENTS: ^ 1131 (^ <br />