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Date mn 2/11/2014 12:46:35PI SAN JO�JIN COUNTY ENVIRONMENTAL HEAIuDEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/11/2014 <br /> Record Selection Cntena: Facility ID FA0012408 <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 OW0009621 New Owner ID <br /> Owner Name BRAGG COMPANIES <br /> Owner DBA BRAGG COMPANIES <br /> Owner Address 6251 PARAMOUNT BLVD <br /> LONG BEACH, CA 90805 <br /> Home Phone 800-944-5623 <br /> Work/Business Phone Not Specified <br /> Mailing Address 6251 PARAMOUNT BLVD <br /> LONG BEACH, CA 90805 <br /> Care of KUPFER, OWEN <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS to FA0012408 <br /> Facility Name HEAVY TRANSPORT INC <br /> Location 2420 E EIGHT MILE RD <br /> STOCKTON, CA 95210 <br /> Phone 800-327-8694 <br /> Mailing Address PO BOX 8389 <br /> STOCKTON, CA 95208 <br /> Care of SABIN, LORIN <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> SOS District 004-VOGEL, KEN Fax <br /> APN 12002014 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0020265 New Account ID: <br /> Maillnvoicesto Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name BRAGG COMPANIES (Circle One) <br /> Account Balance as of 2/11/2014: $0.00 <br /> (Circle One) <br /> Transfer to ActiveMactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO520838 EE0008709-JAMIE DE LA ROSA Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO515985 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO515987 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO515989 EE0009999-SITE UNASSIGNED Inactive Y N A I D <br /> Q'C4 -AST EXEMPT FAC <1,320 GAL PRO516623 EE0004636-GARRETT 13ACKUS Inactive Y N I D <br /> 740-WASTE TIRE SITE-EXEMPT PRO524828 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533102 Inactive Y N /1;71 I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSfEHD houdy charges associate with thisfacility <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 accordancewith all applicable Ordinance Codes andor Standards and State andor <br /> Federal Laws. ot5e� I 14 <br /> APPLICANT'S SIGNATURE: u Date <br /> Program Records to be TRANSFERED: •$25.00= Amount Paid Date / I <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Receiv d <br /> REHS: �J n Date Z / / Account out: Date <br /> COMMENTS: dA 1P/QaS3S L3 o Cl9z/, PIf�Q 53 $' 6aLf- C22aa ) 'PGe� 7 D <br />