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Date run 2113/2015 11:02:53A1 SAN JC VIN COUNTY ENVIRONMENTAL HEA l DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/13/2015 <br /> Record Selection Criteria: Facility ID FA0003731 <br /> Make changes/corrections in RED ink. ` <br /> INFORMATION CHANGE(date) —I 3I)r7 <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0002772 New Owner ID <br /> Owner Name Don Precissi <br /> Owner DBA PRECISSI FLYING SVC INC <br /> Owner Address 11919 N LOWER SACRAMENTO RD <br /> LODI, CA 95242 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-951-1400 <br /> Mailing Address 11919 N LOWER SACRAMENTO RD <br /> LODI, CA 95242 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0003731 10181357 <br /> Facility Name PRECISSI FLYING SERVICE <br /> Location 11919 N LOWER SACRAMENTO RD <br /> LODI, CA 95242 <br /> Phone 209-369-4408 x <br /> Mailing Address 11919 N LOWER SACRAMENTO RD <br /> .f(eq/ LODI, CA 95242 !� <br /> Care of 9OTfPrecissi <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 05902047 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name -per Precissi P(ZeC4 15 I <br /> Title Pilot <br /> Day Phone 209-369-4408 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION O (Ljc-) <br /> i a LAI-Jp1 al_ <br /> Account ID AR0003310 }l/� ' New Account ID: <br /> Mail Invoices to Account p�V\, Mail Invoices to: Owner / Facility / Account— <br /> Account Name PRECISSI FLYINGSERVIC;E 132�%< I0�UCL (Circle One) <br /> Account Balance as of 2/13/2015: $1,324.00 _�3 t r',�(p-1 t <br /> �7 Q Z 2— (Circle ) <br /> IOU Iti 0 Transfer to nactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0519529 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513761 EE0001422-ARIS VELOSO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511590 EE0000000-HAZ MAT SJC OES InactivE Y N A I D <br /> 2332-EXEMPT TANK FACILITY PR0232509 EE0001422-ARIS VELOSO Active,l Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0506666 EE0000418-MICHAEL KITH InactivE Y NA D <br /> nf�3 'AST FAC 10 K-</=100 K GAL CUMULATIVE PR0521780 EE0001422-ARIS VELOSO Active Y N D <br />!� ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533194 InactivE Y N D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. ,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHS/EHD hourly charges associated with this facility <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 accordance with all applicable Ordinance Codes andror Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by � <br /> REHS: i_ Date ? l �5 Account out: L45 Date <br /> COMMENTS: <br />