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Datew 8131/2011 3:57:33PR SAN J( -JUIN COUNTY ENVIRONMENTAL HEA""H DEPARTMENT Report 05021 <br /> Run by eeleiPagel <br /> Facility Information as of 8/31/2M <br /> Record Selection CdWw FWW 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 FREITAS, SAM a 90 ��rici Iv n r¢— <br /> Owner DBA S'f"a rr D ro <br /> Owner Address 10121 RIVER FALLS CIR -t-1-Zo C is l,� I'I 'le-- 0 <br /> STOCKTON, CA 95209 �ri>�_lGFcv , C 95zio <br /> Home Phone Not Specified <br /> Work/BusinessPhone 209-474-0294 f7AG �i73— �O �1 <br /> Mailing Address 10121 RIVER FALLS CIR zu-�-o L= GaLf•E M;la- wa<Y <br /> STOCKTON, CA 95209 ro <br /> Care of FREITAS, SAM lis.,._ <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012408 <br /> Facility Name BRITE TRANSPORTATION ING 2P 44 <br /> Location 2420 E EIGHT MILE RD <br /> STOCKTON, CA 95210 <br /> Phone 209-474-0294 zo ri 2 44 7 3 ^ 9 So•o <br /> Mailing Address 2420 E EIGHT MILE RD <br /> STOCKTON, CA 95210 <br /> Care of FREITAS, SAM fisc. s,--- <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 004-VOGEL, KEN Fax l Zog� [f 73 — quo z <br /> APN 12002014 EMall : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name FREITAS, SAM �S•s l\/a'tivf`a ��90•^ <br /> Title <br /> Day Phone 209-474-0294 el4o0 <br /> Night Phone 209-474-0294 z43 —? 1 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0020265 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner I Facility I Account <br /> Account Name BRITE TRANSPORTATION I C (�Oral) <br /> Account Balance as of 8/31/2011: $5,106.00— c� � p37$7 <br /> 1 (Circle ore) <br /> Trareler to ActivWiracive <br /> Program/Elemerd and Description Record ID Employee ID rid Name Staba New Omer? Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO515987 EE00000D0-HAZ MAT SJC OES Inactive Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PRO515985 EE0004636-GARRETT BACKUS Active N < I D <br /> 2244-PACT TRANSFER RECORD-OES PRO520838 EE0000000-HAZ MAT SJC OES Active Y N A 1 D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0515989 EE0009999-SITE UNASSIGNED Inactive Y N A I D <br /> AST FAC 10 K-</=100 K GAL CUMULATIVEPRO516623 EE0004636-GARRETT BACKUS Active Y N AT� D <br /> -WASTE TIRE SITE-EXEMPT PRO524828 EE0002622-BENJAMIN ESCOTTO Active Y N A I l�D <br /> ERSC-ELECTRONIC REPORTING STATESURCHPRO533102 Active Y N A I XIV <br /> BILLING end COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or apart of same,ackmWedge that all site,and/or project spec0c,PHS/EHD Cloudy cfrges associated wkh this <br /> facary w activity wa be baled to tre wry kbntlMd as the OWNER on INS roan. I also,certify that all operatiors will oe performed In accordance wird all applicable Ordinece Codes and/or Standards and <br /> State andror Federal Laws. <br /> APPLICANTS SIGNATURE: Date / I <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: Amount Paid Date I / <br /> Payment Type Check Number Rete y <br /> RENS: Date /__1L/2z_ Account out: Date <br /> COMMENTS: `=� 1 y Z <br /> '7 —ft= Z22U G-'-F� c<.-l-r✓cam `.3�3r/// <br /> 1\nH_an,Aun,Aelnn\rnnnrle\Yr\71 elf—_� G / e"` �� / �� <br />