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Dale run 7/1/2014 8:11:02AM SAN JO,. AN COUNTY ENVIRONMENTAL HEAL Report#5021 <br />DEPARTMENT Repel <br />Run by Facility Information as of 7/1/2014 <br />Record Selection Cdtena'. Facility ID FA0014716 <br />OWNER FILE INFORMATION Number of facilities for this owner <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 />Mailing Address <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 />SOS District <br />DES MOINES, IA 50306 <br />Care of <br />01321051 <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0014716 10184779 <br />Facility Name <br />RUAN TRANSPORT CORP <br />Location <br />19601 N HWY 99 <br />ACAMPO, CA 95220 <br />Phone <br />209-367-8753 x0 <br />Mailing Address <br />PO BOX 855 <br />DES MOINES, IA 50306 <br />care of <br />Joe Azevedo <br />Location Code <br />99 - UNINCORPORATED P <br />SOS District <br />004 - VOGEL, KEN <br />APN <br />01321051 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0025023 <br />Mail Invoices to Owner <br />Account Name RUAN TRANSPORT CORP <br />Account Balance as of 7/1/2014: $0.00 <br />1 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New Owner ID : _ <br />Alt Phone <br />Fax <br />EMail : <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1921 - HMBP-Regular-Primary Location PRO521642 EE0008709 - JAMIE DE LA ROSA Active Y N A(I / D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0534198 Inactiv( Y N A '�( D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT'. I, the undersigned owner, operator or agent of same, atlmowledge that all site, endor project specific, PHSEHD hourly charges associated with this facility <br />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 andor Standards and State ands <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 />Payment Type Check Number Receive I <br />REHS: IL1.., )� Date /�_I Account out: Date T/Tl <br />COMMEryTg� <br />