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Datemn 12/8/2011 2:44:11PN SAN.JWIN COUNTY ENVIRONMENTAL HEAW DEPARTMENT Report#5o21 <br /> Run by Pagel <br /> Facility Information as of 12/8/2 <br /> Record Selection Criteria: Facility ID FA0018219 <br /> Make changes/corrections in RED ink. 11 <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002849 New Owner ID <br /> Owner Name WINN, D H <br /> Owner DBA DH WINN TRUCKING INC <br /> OwnerAddress 12505 E BRANDT RD <br /> LOCKEFORD, CA 95237 <br /> Home Phone 209-727-5608 <br /> Work/Business Phone 209-727-5531 <br /> Mailing Address PO BOX 400 <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018219 <br /> Facility Name D H WINN TRUCKING INC <br /> Location 12505 E BRANDT RD <br /> LOCKEFORD, CA 95237 <br /> Phone 209-727-5531 <br /> Mailing Address PO BOX 400 <br /> LOCKEFORD, CA 95237 <br /> Care of WINN, D H <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 05132010 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DH WINN <br /> Title <br /> Day Phone 209-727-5531 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032059 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name D H WINN TRUCKING INC (Circle One) <br /> Account Balance as of 12/8/2011: $5,532.00 <br /> (Circle One) <br /> Program/Element and DescriptionRecord ID Employee ID and Name Status Transfer to Active/Inactve <br /> New Omer? Delete <br /> QgZP SM HW GEN<5 TONS/YR PR0526899 EE0001422-ARIS CACAPIT Active Y N A D <br /> 2244-PACT TRANSFER RECORD-OES PR0527523 Inactive Y N A I D <br /> P-AST FAC 10 K-</=100 K GAL CUMULATIVEPRO526901 EE0001422-ARIS CACAPIT Active Y N A 0 D <br /> -WASTE TIRE SITE-EXEMPT PR0526900 EE0002622-BENJAMIN ESCOTTO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPRO532979 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 /> adlity 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 /> Sta o�a�nddlorr I ede�Laws.1"✓`l/V t`�/ <br /> C <br /> APPLI NT'S SIGNATURE: Date <br /> Program Records to be TRANSFEREO: "$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Cyneck Number Received by <br /> RENS: �`21' Date 1l—/�_/ tl Account out: Date_/ / <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />