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Date run -6/18/.20M 2:48:14PN SAN,' `QUIN COUNTY ENVIRONMENTAL HF TH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/18/�u08 <br /> Record Selection Criteria: Facility ID FA0010019 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008019 Case Number: H06259 New Owner ID <br /> Owner Name FRED ALBERG <br /> Owner DBA FRED ALBERG TRUCKING <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-333-8360 <br /> Mailing Address PO BOX 575 <br /> LODI, CA 95241 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010019 <br /> Facility Name FRED ALBERG TRUCKING <br /> Location 13410 N LOWER SACRAMENTO RD <br /> LODI, CA 95242 <br /> Phone 209-368-6705 <br /> Mailing Address PO BOX 575 <br /> LODI, CA 95241 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 058-070-06 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 AR0017019 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name FRED ALBERG (Circle One) <br /> Account Balance as of 6/18/2008: $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 /> 2220 SM HW GEN<5 TONS/YR PRO514130 EE0001422-ARIS CACAPIT Inactive Y N A I D <br /> 2221 -USED OIL ONLY-<5 TONS/YR PR0517419 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512307 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520027 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR1PR0510019 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR1PR0517420 EE0001422-ARIS CACAPIT Inactive Y N A D <br /> 28;1BB6 AST FAC>/=100 M+1 GAL CUMULATIVE PR0517418 EE0004636-GARRETT BACKUS Active Y N A I D <br /> �ILLlVand COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges ass i with this <br /> facility 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 Ordinace Codes and/or St dards and <br /> State and/or Federal Laws. i <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: "$372.00= Amount Paid Date <br /> Payment Type Check Number Receive <br /> REHS: Date / / Account out: Date / Z22 <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />