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ate Nn- k12212010 12:35:07P1 SAN 3C"OUIN COUNTY ENVIRONMENTAL HEAL '4--I DEPARTMENT Report#5021Pagel <br /> Run:y 5290 J✓ Facility Information as of 412212(}' <br /> Record Selection Criteria: Facility ID FAOD05257 <br /> Make changeslcorrections in RED ink. t <br /> INFORMATION CHANGE(date) "f��iL�l Q — <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN!Fed Tax 10 <br /> Owner ID OW0004114 New Owner ID <br /> Owner Name GUARDING, SAL R ETAL <br /> Owner DBA GUARDINO BROS <br /> Owner Address 17227 E MILTON RD <br /> LINDEN, CA 95236 <br /> Home Phone Not Specified <br /> WorklBusiness Phone Not Specified <br /> Mailing Address 17227 E MILTON RD <br /> LINDEN, CA 95236 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0005257 <br /> Facility Name GUARDINO BROS - <br /> Location 17227 E MILTON RD <br /> LINDEN, CA 95236 5• <br /> Phone 209-522-7210 x0 <br /> Mailing Address 17227 E MILTON RD <br /> LINDEN, CA 95236 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 10510012 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005715 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name GUARDINO, SAL R ETAL <br /> Account Balance as of 412212010: $0.00 , <br /> (Circe On } <br /> Transfer to Activeiinaclve <br /> ProgramlElement and Description Record ID Employee IO and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSIYR PR0530186 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO525876 Active Y N A I D <br /> 2333-FARM UST#1 FACILITY-obsolete PRO601893 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0530185 EE0009488-JEFFREY WONG Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0533988 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT; I,the undersigned owner,operator or agent of same,acknowledge that alt site,and/or project specific,PHSlEHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. 1 also certify that all operations w ll be performed in accordance with alt applicable Ordinate Codes and/or Standards and <br /> State andlor Federal Laws, <br /> APPLICANT'S SIGNATURE: Date I ! <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date I ! <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date ! / <br /> Payment Type Check Number Recei.vgd by <br /> REHS: Date 1 ! Account out: (� Date <br /> COMMENTS: <br /> 11e h-envlenvisionlreports15021.rpt <br />