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Date run 4/13/2010 12:56:49PI SAN JO`r1UIN COUNTY ENVIRONMENTAL HEAL TH DEPARTMENT Report 715021 <br /> Runby , 1273 Pagel <br /> -� Facility Information as of 4/13/201d' <br /> Record Selection Criteria: Facility ID FA0010157 <br /> n Make changes/corrections in RED ink. <br /> I �V INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008157 Case Number: H0694� New Owner iD : <br /> Owner Name FES SYSTEMS 6'e.19 F6 -5 lN� <br /> Owner DBA FES SYSTEMS INC <br /> Owner Address 3475 BOARD RD <br /> YORK, PA 17402 <br /> Home Phone Not Specified <br /> Work/Business Phone 717-767-6411 <br /> Mailing Address PO BOX 2306 <br /> YORK, PA 17405 <br /> Care of <br /> FACILITY FILE INFORMATION �r <br /> Facility ID FA0010157 LTG IQ F L S <br /> Facility Name FES PACIFIC SYSTEMS <br /> Location 3210 N AD ART RD B-1 <br /> STOCKTON, CA 95215 <br /> Phone 209-931-3970 <br /> Mailing Address 3210 N AD ART RD UNIT B1 <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOIS District 002 - RUHSTALLER, LARRY Fax <br /> APN 087-100-42 EMaii: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017157 New Account ID: <br /> Mail Invoices to Owner / Mail Invoices to: Owner / Facility / Account <br /> Account NamerFEg$q$TEIVU e7-5 (Circle One) <br /> Account Balance as of 4/13/2010: $0.00 <br /> (Circle One) <br /> Transferto Activellnactve <br /> Program/Eamem and Description Record ID Employee ID and Name Stalus New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514204 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512445 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-IDES PR0521128 EEOOOOOOO-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARFIR0510157 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0534470 Active 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 certgy that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State andlor Federal Laws. <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 Racal d y <br /> REHS: Date / / Account out: Date)F/ /10 <br /> COMMENTS: <br /> \\eh-env\envision\reports15021.rpt <br />