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Date run 1/28/2011 3:42:20PN SAN Jr `UIN COUNTY ENVIRONMENTAL HE/ A DEPARTMENT <br /> Report#5021 <br /> Run by 5290 <br /> Facility Information as of 112812 Pagel <br /> Record Selection Criteria: Facility 1D FA0010519 <br /> Make Cha slcorrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> 1 <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> 'V/ <br /> SSN!Fed Tax ID <br /> Owner ID OWOQO$519 New Owner ID <br /> Owner Name SINGH, VINCENT T <br /> Owner DBA <br /> Owner Address 9956 CASTELLI CT <br /> ELK GROVE, CA 957573 12 <br /> Home Phone 916-296-0038 <br /> Work/Business Phone 209-941-4000 <br /> Mailing Address 9956 CASTELLI CT <br /> ELK GROVE, CA 957573012 <br /> Care of SINGH, VINCENT T <br /> FACILITY FILE INFORMATION <br /> Facility tD FA0010519 <br /> Facility Name AAMCOITRANS TRANSMISSIONS <br /> Location 2510 MONTE DIABLO AVE <br /> STOCKTON, CA 952031126 <br /> Phone 209-941-4000 <br /> Mailing Address 2510 MONTE DIABLO AVE <br /> STOCKTON, CA 95203 <br /> Care of SINGH, VINCENT T <br /> Location Code 01 -STOCKTON Ait Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 13311133 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name VINCENT T SINGH <br /> Title OWNER <br /> Day Phone 269-941-4000 <br /> Night Phone 510-754-9184 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017519 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner I Facility ! Account <br /> Account Name AAMCOITRANS TRANSMISSIONS (Circle One) <br /> Account Balance as of 1/2812011: $0.00 <br /> {Circle One) <br /> Transfer to Activellnactv0 <br /> ProgramlElemeni and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSIYR PRO514364 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512807 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO521066 EEOOOOOOO-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR1PR0510519 EEO000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0529656 EE0001421 -STACY RIVERA Active,Exempt Y N A I <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0533307 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT; I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project spec,PHSIEHO hourly charges assoaal with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. f also certify that all operations will he performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State andlor Federal Laws. <br /> APP'LICANT'S SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date / 1 <br /> Water System to be TRANSFERED: _ Amount Paid Date ! ! <br /> Payment Type /C ck Number Receiv d y <br /> REHS: Date .� lI_ Account out: <br /> COMMENTS: <br /> 11eh-envlenvisionlreports15021.rpt <br />