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Date run 2/19/2014 7:57:34Ah SAN JO'�D 7IN COUNTY ENVIRONMENTAL HEADEPARTMENT Repert#5021 <br />RunPagel <br />es <br />Facility Information as of 2/19/2014 <br />Record Selection Caters: Facility ID FA0014716 <br />Make changes/corrections in RED ink./ <br />INFORMATION CHANGE (date) 6 <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0011727 <br />Owner Name <br />RUAN TRANSPORT CORP <br />owner DBA <br />RUAN TRANSPORT CORP <br />Owner Address <br />19601 N HWY 99 <br />ACAMPO, CA 95220 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />515-245-5687 <br />Mailing Address <br />PO BOX 855 <br />DES MOINES, IA 50306 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility lD/CERS ID FA0014716 10,184,779 <br />SSN/Fed Tax ID <br />New Owner ID : <br />Facility Name RUAN TRANSPORT CORP <br />Location 19601 N HWY 99 <br />ACAMPO, CA 95220 <br />Phone 209-367-8753 x0 <br />Mailing Address PO BOX 855 <br />DES MOINES, IA 50306 <br />Care of <br />Location Code 99 - UNINCORPORATED P Alt Phone <br />BOS District 004 - VOGEL, KEN Fax <br />APN 01321051 EMail: <br />EMERGENCY NOTIFICATION CONTACT INFORMATION �J <br />Contact Name <br />Title l <br />Day Phone <br />Night Phone p O <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0025023 Y 1 Ci \ New Account ID: <br />Mail Invoices to Owner` Mail In ices to* Owner I Facility / Account <br />Account Name RUAN TR P T CORPJ�� Y (Circle One) <br />Account Balance as of 2/19/2014: 90.00 d, <br />n (Circle One) <br />C Transfer to Active/InacNe <br />Program/Element and Descnption Record! ID Employee ID and Name Status New Owm a? Delete <br />1921 - HMBP-Regular-Primary Location PR0521642 EE0008709 - JAMIE DE LA ROSA Active Y N A 1 D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0534198 Inactive Y N A D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andor project specific, PHS/EHD hourly charges associated with this f solity <br />or activity will be billed to the party identified as the OWNER on this fanol also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Stimcards and Stale ander <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: * $25.00 = Amount Paid Date /_/ <br />Water System to be TRANSFERED: Amount Paid Date <br />Paymentr Thy Check Number Iq Re by <br />REHS: <br />Payment bl .L Date 2 /y/ I Account out: Date - / a /L <br />COMMENTS:iS lOCa e� ct,% l�'S01 l�iwy 9L <br />is ckd dI <br />ri �2 (I�E rn,v� ,fie 1S no0.c{ \re OmFW � IGS�I . ` Lr�S <br />-Lace- sL�rw� <br />5b2( f� Et r� aJcLre`s col -+ 4 C hem icr,Js +D V;le ID Ot- d - 1'h IN W <br />