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ERecord <br /> 14/1/2010 11:29:04AI SAN JO"RUIN COUNTY ENVIRONMENTAL'HEAJ T Re ortf�sort <br /> 1; H DEPARTMENT p <br /> Facility Information as of 1011/2 . <br /> Pagel <br /> ection Criteria: Facifity ID FA0016995 <br /> I - <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) I c7j IIID <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> SSN/Fed Tax ID <br /> Owner ID OW0013836 New Owner ID <br /> Owner Name AE DIXON &SONS <br /> Owner DBA AE DIXON A SONS <br /> Owner Address 27669 N THORNTON RD <br /> THORNTON, CA 95686 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 125 <br /> THORNTON, CA 95686 <br /> Care of DIXON, LESLIE <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016995 <br /> Facility Name AE DIXON &SONS <br /> Location 27669 N THORNTON RD <br /> THORNTON, CA 95686 <br /> Phone 209-794-2533,x0 <br /> Mailing Address 27669 N THORNTON RD <br /> THORNTON, CA 95686 <br /> Care of DIXON, LESLIE <br /> Location Code 99—UNINCORPORATED A Alt-Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 00113043 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 AR0029877 �[}�` '� New Account ID: <br /> Mail Invoices to Owner Fk Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name AE DIXON &SONS ^�)C� VV (circle Orae) <br /> Account Balance as of 1 011 1201 0: $475.00 w` 4-6 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee 10 and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO529151 EE0001422-ARIS CACAPIT Active Y N A D <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO525180 Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <.1,320 GAL PR0529150 EE0001422-ARIS CACAPIT Active;Exempt Y N A © D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO534041 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,PHSIEHD 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 Ordinate Codes and/or Standards and <br /> state and/or Federal Laws. <br /> Qw Mr• L"11e VICenf I'i14WWS.CW 114 <br /> APPLICANT'S SIGNATURE: Date 1 / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: Amount Paid Dsite ! / <br /> Payment Type Check Number Recei y <br /> RENS: Date I 1 Account out: Date <br /> COMMENTS: <br /> lleh-envlenvisionlreports15021.rpt <br />