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Date run 7/29/2008 9:15:11Ah SAN JOA <br />Run by <br />Record Selection Criteria: Facility ID FA0003852 <br />OWNER FILE INFORMATION <br />N COUNTY ENVIRONMENTAL HEAL" DEPARTMENT <br />Facility Information as of 7/29/200b <br />Owner ID <br />OW0002849 <br />Owner Name <br />WINN, D H <br />Owner DBA <br />DH WINN TRUCKING INC <br />Owner Address <br />19555 N TULLY RD <br />LOCKEFORD, CA 95237 <br />Home Phone <br />209-727-5531 <br />Work/Business Phone <br />209-727-5056 <br />Mailing Address <br />PO BOX 400 <br />LOCKEFORD, CA 95237 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID FA0003852 <br />Facility Name D H WINN TRUCKING INC <br />Location 19555 N TULLY RD <br />I LOCKEFORD, CA 95237 <br />Phone 209-727-5531 <br />Mailing Address PO BOX 400 <br />LOCKEFORD, CA 95237 <br />Care of <br />Location Code 99 - UNINCORPORATED P <br />BOS District 004 - VOGEL, KEN <br />APN 01902036 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0003440 <br />Mail Invoices to Facility <br />Account Name D H WINN TRUCKING INC <br />Account Balance as of 7/29/2008: $820.00 <br />Program/Element and Description <br />Record ID Employee ID and Name <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 />New Account ID: <br />Mail Invoices to: Owner / <br />Status <br />Report #5021 <br />Pagel <br />Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />New Owner? Delete <br />2220 - SM HW GEN <5 TONS/YR PRO514105 EE0001422 - ARIS CACAPIT Inactive Y N A I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512233 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D <br />2244 - PACT TRANSFER RECORD - OES PR0519978 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D <br />2381 - UST FACILITY (BEFORE 1/84) - obsolete PR0231738 EE0004636 - GARRETT BACKUS Inactive Y N A I D <br />2 - UNIFIED PROGRAM FAC STATE SURCHAR�PR0507502 EE0004636 - GARRETT BACKUS Inactive Y N A I D <br />36 AST FAC >/=100 M + 1 GAL CUMULATIVE PR0515571 EE0004636 - GARRETT BACKUS Inactive Y N A I D <br />47 0 - WASTE TIRE SITE - EXEMPT PR0524258 EE5555555 - Garrett Alias -Backus Inactive 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 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 <br />all operations will be performed <br />dd-iinn accordance ith all applicable t(O�r-d(inace Codes andL/or Standards and/ <br />tate and/or Federa�Laws. <br />�f ��'� <br />-2-47 T <br />APPLICANT'S SIGNATURE: Date <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS, <br />\\phs-ehsgl-nt\apps\envisions\reports\5021. rpt <br />$20.00 = <br />$372.00 = <br />Date <br />A 5- <br />_ Amount Paid Date <br />Amount Paid Date <br />Received <br />Account out: <br />