Laserfiche WebLink
Date run 3/8/2010 11:43:06AM SAN JQA 1UIN COUNTY ENVIRONMENTAL HEAL 'rH DEPARTMENT Report#5021 <br />Run by <br />Pagel <br />Water System to be TRANSFERED: <br />Facility Information as of 3/8/20. _ <br />Record Selection Criteria: Facility ID <br />FA0013634 <br />Payment Type <br />Make changes/corrections in RED ink. , t <br />Receive ti\ <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION <br />SSN / Fed Tax ID <br />Owner ID <br />OW0010747 New Owner ID <br />Owner Name <br />VACCEREZZA, DAVID M <br />Owner DBA <br />CALIFORNIA WASTE RECOVERY SYST <br />Owner Address <br />980 E AUGUSTA ST <br />WOODBRIDGE, CA 95258 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />PO BOX 670 <br />WOODBRIDGE, CA 952580670 <br />Care of <br />DAVID M VACCEREZZA <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0013634 <br />Facility Name <br />CALIFORNIA WASTE RECOVERY SYSTEM <br />Location <br />1065 E TURNER RD <br />LODI, CA 95240 <br />Phone <br />209-369-6887 <br />Mailing Address <br />PO BOX 670 <br />WOODBRIDGE, CA 952580670 <br />Care of <br />DAVID M VACCEREZZA <br />Location Code <br />02 - LODI Alt Phone <br />BOS District <br />004 - VOGEL, KEN Fax <br />APN <br />04902038 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 <br />AR0022789 New Account ID: <br />Mail Invoices to <br />Facility Mail Invoices to: Owner / Facility / Account <br />Account Name <br />CALIFORNIA WASTE RECOVERY SYSTEMS (Circle One) <br />Account Balance as of 3/8/2010: $744.00 <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description <br />Record ID Employee ID and Name Status New Owner? Delete <br />2227 - GEN 5<25 TONS PERMIT PR0528796 EE0001422 - ARIS CACAPIT Active Y N A I D <br />2244 - PACT TRANSFER RECORD - OES PR0527690 Active Y N A I D <br />283 `AST FAC 10 K - </=100 K GAL CUMULATIVEPRO534844 EE0001422 - ARIS CACAPIT Active Y N A I D <br />REFUSE VEHICLES <br />PRO517968 EE0004680 - NATALIA SUBBOTNIKO`Active Y N A I D <br />ERSC - ELECTRONIC REPORTING SURCHARGE PR0532038 Active 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 speck, PHS/EHD hourly charges associated with this <br />facility or activity will be billed to the party <br />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: <br />Date <br />Program Records to be TRANSFERED: <br />' $20.00 = <br />Amount Paid Date <br />Water System to be TRANSFERED: <br />' $372.00 = <br />Amount Paid Date <br />Payment Type <br />Check Number <br />Receive ti\ <br />/ REHS: AIL vat'- <br />Date / <br />/ Account out: Date <br />COMMENTS: <br />\\eh- nv\envision\reports\5021.rpt <br />