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Date run 9/5/2008 8:17:18AM SAN JOAQU <br />Run by . OUNTY ENVIRONMENTAL HEALTHOFARTMENT Report #5021 Facility Information as of 9/5/2008 Pagel <br />I Record Selecuon cntena: racmty, w FA0009860 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0007860 <br />Owner Name <br />WASTEQUIP MANUFACTURING CO <br />Owner DBA <br />WASTEQUIP <br />Owner Address <br />11900 LOCKE RD <br />PR0514065 <br />LOCKEFORD, CA 95237 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-333-4414 <br />Mailing Address <br />11900 LOCKE RD <br />EE0000000 - HAZ MAT SJC DES <br />LOCKEFORD, CA 95237 <br />Care of <br />N <br />FACILITY FILE INFORMATION <br />I D <br />Facility ID <br />FA0009860 <br />Facility Name <br />WASTEQUIP <br />Location <br />11900E LOCKE RD <br />A <br />LOCKEFORD, CA 95237 <br />Phone <br />209-333-4414 <br />Mailing Address 11900 LOCKE RD <br />LOCKEFORD, CA 95237 <br />Care of <br />Location Code 99 - UNINCORPORATED A <br />BOS District 004 - VOGEL, KEN <br />APN 05116004 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0016860 New Account ID: <br />Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br />Account Name WASTEQUIP {YQL� (Circle One) <br />Account Balance as of 9/5/2008: $0.00 <br />(Circle One) <br />Transfer to Activednacive <br />Program/Element and Description <br />Record ID <br />Employee ID and Name <br />Status <br />New Omer? <br />Delete <br />2220 - SM HW GEN <5 TONS/YR <br />PR0514065 <br />EE0001422 - ARIS CACAPIT <br />Active <br />Y <br />N <br />A <br />I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512148 <br />EE0000000 - HAZ MAT SJC DES <br />Inactive <br />Y <br />N <br />A <br />I D <br />2227 - GEN 5<25 TONS PERMIT <br />PRO506913 <br />EEDOOGO08 - LETITIA BRIGGS <br />Inactive <br />Y <br />N <br />A <br />I D <br />2244 - PACT TRANSFER RECORD - OES <br />PR0521034 <br />EED000000 - HAZ MAT SJC DES <br />Active <br />Y <br />N <br />A <br />I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARIPR0509860 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A <br />I D <br />4630 - NTNC WATER SYSTEM <br />WA0515511 <br />EE0005838 -ADRIENNE ELLSAESSEActive <br />Y <br />N <br />A <br />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 Ordinary Codes and/or Standards and <br />Slate and/or Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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: Ili. Date Account out: Date <br />COMMENTS: <br />Add 4'T4o - u00340 Tire sr�e- Wxe.Inpt. <br />\\p hs-ehsq I-nl\apps\envisions\reports\5021. rpt <br />