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Pate run a 5/22/2013 2:45:42PN SAN JUIN COUNTY ENVIRONMENTAL REA* DEPARTMENT Report #5021 <br />Run by Pagel <br />Facility Information as of 5/22/2013 <br />Record Selection Criteria: Facility ID FA0005630 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0004455 <br />Owner Name <br />USA WASTE SYS INC <br />Owner DBA <br />CENTRAL VALLEY WASTE SVCS - TU <br />Owner Address <br />1333 E TURNER RD <br />Active <br />LODI, CA 95240 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />-}{3= --- <br />Mailing Address <br />PO BOX 6700 <br />Active <br />PORTLAND, OR 97228-6700 <br />Care of <br />A 1 ❑ <br />FACILITY FILE INFORMATION <br />Facility lD/CERS ID FA0005630 10,181,903 <br />Facility Name CENTRAL VALLEY WASTE SERVICES <br />Location 1333 E TURNER RD <br />LODI, CA 95241 <br />Phone 209-333-5611 xO <br />Mailing Address PO BOX 6700 <br />PORTLAND, OR 97228-6700 <br />Care of <br />Location Code 02 -LODI <br />BOS District 004 - VOGEL, KEN <br />APN 04933002 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0006263 <br />Mail Invoices to Facility <br />Account Name CENTRAL VALLEY WASTE SERVICES <br />Account Balance as of 5/22/2013: $0.00 <br />Program/Element and Description <br />Make changeslcorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID <br />1154 L t STS tJl-' 1'Dl�lU/D9 1N "� <br />V <br />Alt Phone <br />Fax <br />EMail : <br />Record ID Employee ID and Name <br />Mail Invoices to: <br />1921 - HMBP-Regular-Primary Location PRO519954 EE0008709 - JAMIE DE LA ROSA <br />2217 - APPLIANCE RECYCLER PRO518324 EE0001422 - ARIS CACAPIT <br />2218 - CRT HANDLER PRO518323 EE0001422 -ARIS CACAPIT <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512199 EE0000000 - HAZ MAT SJC OES <br />2229 - GEN 50<250 TONS PERMIT PRO522742 EE0001422 - ARIS CACAPIT <br />2381 - UST FACILITY (BEFORE 1/84) - obsolete PR0502958 EE0004636 - GARRETT BACKUS <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509911 EE0000000 - HAZ MAT SJC DES <br />2832 -AST FAC 10 K - </=100 K GAL CUMULATIVE PRO528795 EE0001422 - ARIS CACAPIT <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PRO533640 <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same cknowiedge that all F&A_A� <br />r project specific, pHs <br />or activi"ll be billed to me party i enl�ed es the OWNER on this for also cert hate perafions I performed in accth all applicable Ordi <br />Federal Lawn. APPLICANTS SIGNATURE: Datte <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: _ Date _ <br />COMMENTS: (Z(jn S-11-1113 <br />11- I t3 <br />$25.00 = <br />(Circle One) <br />Transfer to Acava/lnachm <br />Status New Owner? Delete <br />Active <br />nonce <br />Y <br />N <br />A 1 ❑ <br />Active <br />Y <br />N <br />A 1 D <br />Active <br />Y <br />N <br />A 1 D <br />Inactive <br />Y <br />N <br />A 1 0 <br />Active <br />Y <br />N <br />A 1 ❑ <br />Inactive <br />Y <br />N <br />A I C <br />Inactive <br />Y <br />N <br />A I C <br />Active <br />Y <br />N <br />A I C <br />Inactive <br />Y <br />N <br />A I C <br />/EHD hourly charges associated with this facility <br />Codes ardor Standards <br />and State endbr <br />Amount Paid Date // <br />_ Amount Paid Date <br />Rec <br />Account out:?fr Date::/13 <br />