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Report#5021 <br /> Date run 311312012 4:31:11K SAN.lOr-'JIN COUNTY ENVIRONMENTAL HEAL " -I DEPARTMENT Pagel <br /> A.. ` <br /> Run by Facility Information as:Of 3113120 <br /> Record Section Criteria: Facility ID FAGO09637 <br /> Make changeslcorrections in RED ink. f <br /> INFORMATION CHANGE(date) 1 t <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID <br /> Owner ID OW0007637 New Owner ID <br /> Owner Name LODUCA,VINCENT P JR <br /> Owner DBA VPL TRANSPORT INC <br /> Owner Address 11199 N HWY 99 - <br /> LODI, CA 95240 <br /> Home Phone 209-644-2303 <br /> work/Business Phone 209-644-2307 <br /> Mailing Address ` <br /> 508 fl 5 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA00ID9637 <br /> Facility Name VPL TRANSPORT INC <br /> Location 11199 N HWY.99 <br /> LODI, CA 95240 <br /> Phone 209-368-1369 <br /> �i <br /> Mailing Address <br /> oR VL <br /> S- LQ <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL,-KEN <br /> Fax <br /> r APN 05914064 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 AR0016637 New Account ID: <br /> Mail Invoices to Facility Mail Invoices W Owner 1. Facility I Account <br /> r Account Name VPL TRANSPORT INC (Circle One) <br /> Account Balance as of 311312012: $637.00'- : <br /> (Circle One) <br /> Transfer to Activellna,-I- <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921-HMBP-Regular-Primary Location PR0519791 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO523404 'EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511925 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARiPRO509637 EE0000000-HAZ MAT SJC OES Inactive Y N A 1 . D <br /> !2831-AST FAC >1=1,320-<-16-K GAL COMLiLATi\PRO528242 EE0001422-ARIS CACAPIT Active,Exempt Y N A 1 D <br /> 4740-WASTE TIRE SITE—EXEMPT PR0524068 EE0007379-AMANDA BOERTIEN Inactive Y N A I D <br /> E. <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0534203 Active Y N A I D <br /> i BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> i facility 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 Ordinate Codes antuor Standards and <br /> t State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date, <br /> t Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: Amount Paid Date ! ! <br /> t Payment Type Check Number R ceived by t. <br /> RENS: Pate Account out: Date <br /> COMMENTS: { I' <br /> 11eh-envlenvisionlreports15021.rpt <br />