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Daterun- 1/17/2012 3:56:21PN SAN JOA`IUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Rungy ✓ � 1. Pagel <br /> t , Facility Information as of 1/17/2(. <br /> Record Selection(-tena Facility In FA0000229 <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 OW0000182 New Owner ID <br /> Owner Name SWEET SEPTIC SYSTEMS, INC <br /> Owner DBA SWEET SEPTIC SYSTEM INC <br /> Owner Address 5701 MOTHER LODE DR <br /> PLACERVILLE, CA 95667 <br /> Home Phone Not Specified <br /> Work/Business Phone 530-622-8768 <br /> Mailing Address 5 O <br /> �iZVlno 1 J v �— <br /> Careof <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000229 <br /> Facility Name SWEET SEPTIC SYSTEMS INC <br /> Location 25443 N HWY 99 <br /> ACAMPO, CA 95220 <br /> Phone 209-368-5105 x0 �7 p <br /> Mailing Address <br /> �l?y-^oV1C� LJCf-LVNk S <br /> Care of d /I LC30 <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 00514303 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 AR0000228 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name SWEET SEPTIC SYSTEMS, INC (Circle One) <br /> Account Balance as of 1/17/2012: $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 /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512836 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520414 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR,PR0510548 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2831;AST FAC >/=1,320-<10 K GAL CUMULATRPR0515711 EE0001422-ARIS CACAPIT Active,Exempt Y N A (I D <br /> 4-PUMPER TRUCK PR0420010 EE0000644-TED NORGARD Inactive Y N A I D <br /> 4244-PUMPER TRUCK PR0420101 EE0005366-LISA MEDINA Inactive Y N A I D <br /> 4244-PUMPER TRUCK PRO506067 EE0000644-TED NORGARD Inactive Y N A I D <br /> 4244-PUMPER TRUCK PR0515374 EE0005366-LISA MEDINA Inactive Y N A I D <br /> 4244-PUMPER TRUCK PR0531107 EE0005366-LISA MEDINA Inactive Y N A I D <br /> 4246-PUMPER YARD PR0420044 EE0005366-LISA MEDINA Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0533079 Active Y N A ) D <br /> 1 <br /> \\e h-env\envision\reports\5021.rpt <br />