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Date ran 1/27/2010 12:31:41PI SAN JOA^UIN COUNTY ENVIRONMENTAL HEAT—9 DEPARTMENT Report#5021 <br /> Run by 5290 %001 Pagel <br /> Facility Information as of 1/27/20'Pt7r <br /> Record Selection Criteria: Facility ID FA0017441 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0014282 New caner ID <br /> Owner Name JOHN P DEVINCENZO (t� <br /> Owner DBA JtNCENZO <br /> Owner Address <br /> SAN 5 (� / <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 2899 SEE CANYON RD <br /> SAN LUIS OBISPO, CA 93405 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017441 <br /> Facility Name JOHN P DEVINCENZO Qi F <br /> Location 10351 E ACAMPO <br /> LODI, CA 95240 <br /> Phone 805-595-2646 x0 <br /> Mailing Address 2899 SEE CANYON RD LaSIe S ad- `/-7 D <br /> SAN LUIS OBISPO, CA 93405 <br /> Care of <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 01718010 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 AR0030323 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name JOHN P DEVINCENZO (Circle One) <br /> Account Balance as of 1/27/2010: $0.00 <br /> (Circle One) <br /> Transterto Activelinaclve <br /> Progra"Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO525626 Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528977 EE0001422-ARIS CACAPIT Active,Exempt Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party Identified as the OWNER on this form. I also certify that all operations vrill be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: t,6 Date / /a"-7 <br /> COMMENTS: <br /> JAA"' � llU�hliC /7�J7tC IO&C oe;s &/'yPzt <br /> \\eh-env\envisionVeports\5021.rpt <br />