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Date run 3/6/2014 4:09:52PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 3/6/2014 <br />Record Selection Criteria: Facility ID FA0013634 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0010747 <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 / CERS ID FA0013634 10,184,471 <br />Facility Name CALIFORNIA WASTE RECOVERY SYSTEM <br />Location 1065 E TURNER RD <br />LODI, CA 95240 <br />Phone 209-369-6887 <br />Mailing Address PO BOX 670 <br />WOODBRIDGE, CA 952580670 <br />Care of DAVID M VACCEREZZA <br />Location Code 02 - LODI <br />Bos District 004 - VOGEL, KEN <br />APN 04902038 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Make changes/corrections in RED ink. <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 AR0022789 <br />New Account ID: <br />Mail Invoices to Facility <br />Mail Invoices to: <br />Owner / <br />Facility / <br />Account <br />Account Name CALIFORNIA WASTE RECOVERY SYSTEMS <br />(Circle One) <br />Account Balance as of 3/6/2014: $0.00 <br />(Circle One) <br />Transfer to <br />Active/Inactve <br />Program/Element and Description Record ID <br />Employee ID and Name <br />Status <br />New Owner? <br />Delete <br />1920 - HMBP-Common Materials PRO527690 <br />EE0008709 - JAMIE DE LA ROSA <br />Active <br />Y N <br />A I D <br />2227 - GEN 5<25 TONS PERMIT PR0528796 <br />EE0001422 - ARIS CACAPIT <br />Active <br />Y N <br />A D <br />2831 - AST FAC >/= 1,320 - <10 K GAL CUMULATIVE PR0534844 <br />EE0001422 - ARIS CACAPIT <br />Active,l <br />Y N <br />A D <br />4423 - REFUSE VEHICLES PR0517968 <br />EE0002620 - ALFONSO ARAMBULA <br />Inactive <br />Y N <br />A I D <br />4740 - WASTE TIRE SITE - EXEMPT PRO534997 <br />EE0002620 - ALFONSO ARAMBULA <br />Inactive <br />Y N <br />A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0532038 <br />Inactive <br />Y N <br />A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andror project specific, PHS/EHD <br />hourly charges associated <br />with this facility <br />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 Ordinance <br />Codes and/or <br />Standards <br />and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: " $25.00 = <br />Amount Paid Date <br />Water System to be TRANSFERED: <br />Amount Paid Date <br />Payment Type Check Number <br />Received by <br />REHS: Date -3/1_/ <br />Z4 Accountout: Date <br />COMMENTS: <br />� � � o� <br />Ac. li- 6- ►3 /�,s�c`f�k.-. s� <br />�a� io- <br />f� S D <br />ir.��►t>r., <br />