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Date run 2/1/2016 2:52:26PM SAN JO`JIN COUNTY ENVIRONMENTAL HEATS DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2I1I2016 <br /> Record Selection Criteria: Facility ID FA0003757 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 4 SSN/Fed Tax ID <br /> Owner ID OW0002792 New Owner ID <br /> Owner Name DJ-LMG STOCKTON INC <br /> Owner DBA STOCKTON RECORD <br /> Owner Address 530 E MARKET ST <br /> STOCKTON, CA 95202 <br /> Home Phone 209-546-8245 <br /> Work/Business Phone 209-546-8243 <br /> Mailing Address PO BOX 900 <br /> STOCKTON, CA 95201 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility lD/CERS ID FA0003757 10181385 <br /> Facility Name DJ-LMG STOCKTON INC <br /> Location 530 E MARKET ST <br /> Stockton, CA 95202 <br /> Phone 209-546-8243 x <br /> Mailing Address PO BOX 900 <br /> STOCKTON, CA 95201 <br /> Care of Roger Coover <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 14913018 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 AR0003336 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name DJ-LMG STOCKTON INC (Circle One) <br /> Account Balance as of 2/1/2016: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0521093 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0507044 EE0000027-CINDY VO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511362 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PRO515547 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2332-EXEMPT TANK FACILITY PR0231177 EE0000027-CINDY VO Active) Y N AD <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0507045 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532986 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,an Vor project specific,PH8/EHO hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. Ialso certify that all operations will be performed in accordance with all applicable Ordinance Codes anNor 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 <br /> EHD Staff: Date / / Account out: Date I / <br /> COMMENTS: Invoice#: <br /> �Ko 5�-o�sS <br />