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Date run 2/3/2015 2:31:17PM SAN JO AN COUNTY ENVIRONMENTAL HEA" PARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 2/3/2015 <br />Record Selection Criteria: Facility ID FA0011236 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) L - �D - <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN /Fed Tax ID <br />Owner ID OW0009236 Case Number: H09507 New Owner ID <br />Owner Name UNITED RENTALS NORTHWEST INC <br />Owner DBA UNITED RENTALS INC <br />Owner Address 5 GREENWICH OFFICE PARK <br />GREENWICH, CT 06831 <br />Home Phone Not Specified <br />Work/Business Phone 203-622-3131 <br />Mailing Address 1331 COLDWELL AVE <br />MODESTO, CA 95350 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID! CERS ID FA0011236 10184117 <br />Facility Name UNITED RENTALS NORTHWEST INC <br />Location 3818 RHONDA WAY <br />TRACY, CA 95376 <br />Phone 209-832-1200 x0 <br />Mailing Address 1331 COLDWELL AVE <br />MODESTO, CA 95350 <br />Care of <br />Location Code Alt Phone <br />BOS District 005 - ELLIOTT, BOB Fax <br />APN 21225010 Entail: <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0018236 New Account ID: <br />Mail Invoices to Facility Mail Invoices to: Owner / Facility ! Account <br />Account Name UNITED RENTALS NORTHWEST INC (Circle One) <br />Account Balance as of 2/3/2015: $61.00 <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1921 - HMBP-Reqular-Primary Location PR0520769 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D <br />2220 - SM HW GEN <5 TONS/YR PR0524381 EE0002646 - THUY TRAN Inactive Y N A I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513524 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PR0511236 EE0000000 - HAZ MAT SJC OES Inactive Y N A D <br />2K3 - AST FAC >/= 1,320 - <10 K GAL CUMULATIVE PR0528618 EE0002646 - THUY TRAN Active Y N A I D <br />4740 - WASTE TIRE SITE - EXEMPT PR0524696 EE0000060 - JENNIFER FRASE Inactive Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0531901 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 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 Codes andbr Standards and State andror <br />Federal Laws. <br />APPLICANT'S SIGNATURE: Date <br />Program Records to be TRANSFERED: * $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Type Check Number Receiveb <br />REHS: Date �/ 3 / I Account out: Date2- / / /S <br />COMMENTS: <br />'M <br />