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Date run 1/21/2010 2:38:15PN SAN JOA"UIN COUNTY ENVIRONMENTAL HEA" ' q DEPARTMENT Report#5021 <br /> Run by 5290 Pagel <br /> Facility Information as of 1/21/2(, <br /> Record Selection Criteria: Facility ID FA0017565 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0014406 New Owner ID : <br /> Owner Name ALEX DELU & SON ,Z.U V4 w E VAk PS W C� <br /> Owner DBA ALEX DELU & SON Zt=� L{ ���1y Rk b 5 ►J <br /> Owner Address 15175 N DE VRIES RD <br /> LODI, CA 95242 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 15175 N DE VRIES RD <br /> LODI, CA 95242 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017565 ViNE YA ZPS INC- <br /> Facility <br /> NCFacility Name ALEX DELU & SON <br /> Location 15535 N DE VRIES RD <br /> LODI, CA 95242 <br /> Phone 209-334-6660 x0 <br /> Mailing Address 15175 N DE VRIES RD <br /> LODI, CA 95242 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 - VOGEL, KEN Fax <br /> APN 02514014 EMail . <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030447 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ALEX DELU & SON (Circle One) <br /> Account Balance as of 1/21/2010: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSIYR PR0529684 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO525750 Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0529683 EE0001422-ARIS CACAPIT Active,Exempt 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 hourty 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 and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: 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: Date / / Account out: L Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rot <br />