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Date run 8/4/2008 2:59:49PM SAN JO' 'IN COUNTY ENVIRONMENTAL HEA` DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/4/2000 <br /> Record Selection Criteria: Facility ID FA0005180 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0013211 New Owner ID <br /> Owner Name VERNON TRANSPORTATION <br /> Owner DBA VERNON TRANSPORTATION <br /> Owner Address 2313 W NAVY DR <br /> STOCKTON, CA 95206 <br /> Home Phone 209-546-0171 <br /> Work/Business Phone Not Specified <br /> Mailing Address 2313 W NAVY DR <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0005180 <br /> Facility Name VERNON TRANSPORTATION <br /> Location 2313 W NAVY DR <br /> STOCKTON, CA 95206 <br /> Phone 209-546-0171 <br /> Mailing Address 2313 NAVY DR <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 - GUTIERREZ, STEVE Fax <br /> APN 16332005 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ROBERT SMITH <br /> Title <br /> Day Phone 916-371-4960 <br /> Night Phone 916-371-4960 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005628 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name VERNON TRANSPORTATION (Circle One) <br /> Account Balance as of 8/4/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0501664 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO524344 EE0004045-TED TASIOPOULOS 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 specific,PHS/EHD hourly charges associated with this <br /> 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws, <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\p h s-ehsql-n t\apps\e nvis ions\reports\5021.rpt <br />