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Date run 6/12/2008 3:18:36Ph SAN.-F QUIN COUNTY ENVIRONMENTAL HL�i H DEPARTMENT Repoli#5U21Pagel <br /> Run by Faciiity information as of 6/12/2008 <br /> r 1 <br /> Record Selection Criteria: Facility ID FA0009298 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN 1 Fed Tax ID <br /> Owner tD OW0007298 Case Number: H02933 New Owner ID <br /> Owner Name , <br /> Owner DBA V 17 <br /> Owner Address <br /> Home Phone -Net SpeGf ied <br /> Work/Business Phone - <br /> Mailing Address Pe-$p"26 <br /> 690 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009298 <br /> Facility Name WALNUT GROVE TRANSPORTS <br /> Location 10601 W WALNUT GROVE RD <br /> THORNTON, CA 95686 <br /> Mailing Address 1"'6-B9?r 26 <br /> 0 <br /> Care of r«oov R 5.rnr.ruS <br /> Location Code,99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 00108013 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account lD AR0016298 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner I Facility 1 Account <br /> Account Name WALNUT GROVE TRANSPORTS (circle one) <br /> Account Balance as of 6112/2008: $0.00 <br /> (Circle One) <br /> Transfer to Aclivellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2221 -USED OIL ONLY-<5 TONSIYR PRO513759 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511586 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1184)-obsolete PRO504441 EE0004636-GARRETT BACKUSInaC e Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PR0515759 EE0004636-GARRETT BACKUS Inactive ✓ Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0509298 EE0000000-HAZ MAT SJC OES ve 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 Ordinace Codes andlor Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date 1 1 <br /> Payment Type Check Number Receiv <br /> REHS: Date I I Account out: V Date I I1 <br /> COMMENTS: <br /> llphs-ehsgl-ntlappslenvisionslreports15021.rpt <br />