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Date run , 3/7/2008 10:50:34AM SAN JC ' `2UIN COUNTY ENVIRONMENTAL HEt - —H DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 3/7/2Uud <br />Record Selection Criteria: Facility ID FA0004518 <br />OWNER FILE INFORMATION <br />Owner ID OW0000482 <br />Owner Name <br />SJC PUBLIC WORKS <br />Owner DBA <br />Y <br />Owner Address <br />1810 E HAZELTON AVE <br />D <br />STOCKTON, CA 95205 <br />Home Phone <br />209-468-3031 <br />Work/Business Phone <br />209-948-1345 <br />Mailing Address <br />222 E WEBER AVE 6TH FL <br />2220 - SM HW GEN <5 TONS/YR PR0523369 <br />STOCKTON, CA 95202 <br />Care of <br />PUBLIC WORKS <br />FACILITY FILE INFORMATION <br />Facility ID FA0004518 <br />Facility Name NORTH COUNTY LANDFILL <br />Location 17900 E HARNEY LN <br />LODI, CA 95240 <br />Phone 209-468-3066 <br />Mailing Address PO BOX 1810 <br />STOCKTON, CA 95201 <br />Care of PUBLIC WORKS DEPARTMENT <br />Location Code 99 - UNINCORPORATED AREA <br />BOS District 004 - VOGEL, KEN <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0004201 <br />Mail Invoices to Facility <br />Account Name NORTH COUNTY LANDFILL <br />Account Balance as of 3/7/2008: $6,466.50 <br />Program/Element and Description <br />Record ID Employee ID and Name <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) X1'_7 - 6(� <br />OWNERSHIP CHANGE (date) <br />New Owner ID : <br />APN:06512004 <br />SIC Code: <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Status New Owner? Delete <br />2217 - APPLIANCE RECYCLER PR0523556 <br />EE0001422 - ARIS CACAPIT <br />Active <br />Y <br />N <br />A I <br />D <br />2218 - CRT HANDLER PRO518299 <br />EE0004636 - GARRETT BACKUS <br />Active <br />Y <br />N <br />A I <br />D <br />2220 - SM HW GEN <5 TONS/YR PR0523369 <br />EE0001422 - ARIS CACAPIT <br />Active <br />Y <br />N <br />A I <br />D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512560 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A I <br />D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARPR0510272 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A I <br />D <br />AST FAC >/=100 M + 1 GAL CUMULATIVE PR0523381 <br />EE0001422 - ARIS CACAPIT <br />Active <br />Y <br />N <br />A I <br />D <br />44 3 - LANDFILL DISPOSAL SITE PR0440058 <br />EE5555555 - Garrett Alias -Backus <br />Active <br />Y <br />N <br />A I <br />D <br />4740 - WASTE TIRE SITE - EXEMPT PR0523816 <br />EE5555555 - Garrett Alias -Backus <br />Active <br />Y <br />N <br />A I <br />D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD <br />hourly charges <br />associated with this <br />facility or activity will be billed to the party identified as the OWNER on this form. I also <br />certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br />State and/or Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: ' $20.00 = <br />Water System to be TRANSFERED: ' $372.00 = <br />Payment Type Check Number <br />REHS: �,�5 %Gc1+n,�- Date <br />J. <br />COMMENTS: <br />\\ph s-ehsq I-nt\apps\envisions\reports\5021. rpt <br />Date / / <br />Amount Paid Date <br />Amount Paid Date <br />Re iv y <br />,K Account out: Re Date / J_?� <br />;>kX k IV),I <br />