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Date run 2122/2010 8:49:19AN SAN Jr 'ZUIN COUNTY ENVIRONMENTAL HEP 'H DEPARTMENT Report#5021 <br /> air Paget <br /> Ren by Facility Information as of 2I22I2�0 <br /> Record Selection Criteria: Facility ID FA0009222 <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 OW0007222 Case Number: H02183 New Owner ID <br /> Owner Name TP CAMPORA/RON CAMPORA <br /> Owner DBA CAMPORA PROPANE SERVICE <br /> Owner Address 2537 S MARIPOSA RD <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/BusinessPhone 209-941-8525 <br /> Mailing Address 1421 N HUNTER ST <br /> STOCKTON, CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009222 <br /> Facility Name CAMPORA PROPANE SERVICE <br /> Location 2525 S MARIPOSA RD <br /> STOCKTON, CA 952057820 <br /> Phone 209-466-8611 <br /> Mailing Address 1421 N HUNTER ST <br /> STOCKTON, CA 95202 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 17130019 EMail : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CHUCK SCHAD <br /> Title MANAGER <br /> Day Phone 209-466-8611 <br /> Night Phone 209-832-5404 ��a <br /> ACCOUNTS RECEIVABLE FILE INFORMATION ° <br /> Account ID AR0016222 � New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CAMPORA PROPANE SERVICE (Circle One) <br /> Account Balance as of 2/22/2010: $884.00 <br /> (Circle One) <br /> Transfer to Activallnaclve <br /> Program/Element and Description Record ID Employee ID and Na Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0513710 EE0008317-RAY OND VON FLUE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511510 EE0000000-HAZ T SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO519475 EEOOOOOOO-HAZMA SJC OES Active Y N A I D <br /> 99-UNIFIED PROGRAM FAC STATE SURCHARPRO509222 EE0o00000-HAZ MAT JC OES Inactive Y N A 1 D <br /> 2832 AST FAC 1 O K-</=100 K GAL CUMULATIVEPRO523162 EE0008317-RAYMOND VON FLUE Active Y N A 0 D <br /> 40-WASTE TIRE SITE-EXEMPT PR0527982 EE0001416-PAUL HAR N Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0534016 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the u ersigned owner,operator ar agent of same,acknowledge all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the parry idemffied as ft OWNER on this form. I also certify that all operators will be pe ad in accordance With all ap ble ina Codas a)kllor Standards and <br /> State arWor Federal Laws. �r �' UR y <br /> APPLICANTS SIGNATURE: Date I / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment��TJy pe Check Number ,\ Receiv <br /> REHS: 1•cy=pA�L L" Date 2 /�1�r�/ (b Account out: Date I / <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />