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Daterun 11/9/2009 9:10:37AR SAN Jf kQUIN COUNTY ENVIRONMENTAL HEP-TH DEPARTMENT Report 05021 <br /> Run by Au/ Pagel <br /> Facility Information as of 11/9/2bE9— <br /> Record Selection Criteria: Facility ID FA0010405 <br /> Make changeelcor ecdons in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) 2� <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008405 Case Number: H08026 New Owner ID : <br /> Owner Name JAMES L ROTT & I �1 <br /> Owner DBA LODI-LOCKEFORD TRACTOR CO <br /> Owner Address 12811 E BRANDT RD tT <br /> LOCKEFORD, CA 95237 <br /> Home Phone Not Specified L`'t <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 650 2 f <br /> LOCKEFORD, CA 95237 0 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010405C k <br /> Facility Name LODI-LOCKEFORD TRACTOR CO DO <br /> Location 12811 E BRANDT RD <br /> LOCKEFORD, CA 95237 <br /> Phone 209-727-5811 — <br /> Mailing Address PO BOX 650 FSO L3ok ? I Zy <br /> LOCKEFORD, CA 95237 [Oct,' Fag 2" !(/ <br /> Care of <br /> Location Code 99-UNINCORPORATED A Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 05131025 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION �ej LL <br /> Contact Name y/LVl�. 43V–A4, <br /> Title l o W <br /> Day Phone 7'US — 17' $� f <br /> Night Phone 9' Y(l <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017405 NewAccount ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name JAMES L ROTT (Cuda One) <br /> Account Balance as of 11/9/2009: $0.00 <br /> (circle One) <br /> Transfer to Activalmscbe <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PR0514313 EED001422-ARIS CACAPIT Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512693 EE0000o00-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520299 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0510405 EE000o000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528605 EE0001422-ARIS CACAPIT Active,Exempt Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,he 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 idemfled as he OWNER on his form. I also certify that all operations will be Performed in accordance With all applicable Ordirace Codes and/or Standards and <br /> Stale anNor Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date ! / <br /> Water System to be TRANSFERED: `$372.00= Amount Paid Date I ! <br /> Payment Type Check Number Raceived/�by <br /> REHS: !?// r /1 /2/y` Date Account out: l _ Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />