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Date run 2/19/2014 9:26:57AN SAN JC JIN COUNTY ENVIRONMENTAL HEA;....ii DEPARTMENT Report#5021 Run by Facility Information as of 2/19/2014 Pagel Record Selection Criteria: Facility ID FA0009636 Make changestcorrections in RED ink. INFORMATION CHANGE(date) OWNERSHIP CHANGE(date) OWNER FILE INFORMATION SSN/Fed Tax ID Owner ID OW0007636 Case Number: H05028 New Owner ID Owner Name CLIFFORD C HAHN Owner DBA HAHN TRACTOR CO INC Owner Address 1777 S ARGONAUT ST STOCKTON, CA 95206 Home Phone Not Specified Work/Business Phone 209-944-0743 Mailing Address PO BOX 2167 STOCKTON, CA 95201 Care of FACILITY FILE INFORMATION Facility ID I CERS ID FA0009636 10,182,815 Facility Name HAHN TRACTOR CO INC Location 1777 S ARGONAUT ST STOCKTON, CA 95206 Phone 209-944-0743 x0 Mailing Address PO BOX 2167 STOCKTON, CA 95201 Care of Location Code 01 -STOCKTON Alt Phone BOS District 001 -VILLAPUDUA Fax APN 16320020 EMail: EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title 4 Day Phone Night Phone 44 0 ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0016636 New Account ID: Mail Invoices to Facility Mail Invoices to: Owner / Facility ! Account Account Name HAHN TRACTOR CO INC (Circle one) Account Balance as of 2/19/2014: $tex3-90� (Circle One) Transfer to Active/lnactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1921 -HMBP-Regular-Primary Location PRO519789 EE0009817-ROBERT LOPEZ Y N AIn D 2220-SM HW GEN<5 TONSIYR PRO528673 EE0002646-THUY TRAN -iii Y N A D 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511924 EE000000O-HAZ MAT SJC OES Inactive Y N A D 2381 -UST FACILITY(BEFORE 1184)-obsolete PRO601908 EE0000451 -STEVE SASSON Inactive Y N A I D 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509636 EE0000000-HAZ MAT SJC OES Inactive Y N A I D 2840-AST EXEMPT FAC < 1,320 GAL PR0528672 EE0002646-THUY TRAN ,I Y N A Cl D ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533507 Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHS/EHD hourly charges associated with this facility or: be billed to the party identified as the OWNER on this form. I also certify that ali operations will be performed in accordance with all applicable Ordinance Codes andlor Standards and Slate ani Federal Laws. APPLICANT'S SIGNATURE: Date 1 ! Program Records to be TRANSFERED: $25.00= Amount Paid Date 1 1 Water System to be TRANSFERED: Amount Paid Date 1 1 Payment Type Check Number 3—/Z- `1 Recei RENS: ate1� 1 Account out: Date I a�I 14 coGYAS�s� �I;vl A iM r� ar