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Date run 4/23/2013 9:39:01AA <br /> Run by SAN JO�jIN COUNTY ENVIRONMENTAL REA7%MIApEPARTMENT <br /> Report 95021 <br /> FaGliry ID FA00099 <br /> Facility Information as of 4/23/2013 Pagel <br /> Recortl Selection Criteria: 48 <br /> Make changes/corrections in RED ink. <br /> 1 INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) — <br /> owner IDOW0007948 Case Number: H05977 New Owner�D ID <br /> Owner Name A&A ROSSI HAY SERVICE <br /> Owner DBA <br /> Owner Address`-}1 AY <br /> MANTECA, CA 95336 0m / Wo <br /> Home Phone 209-609-6954 -- <br /> Work/Business Phone 209-823-3965 <br /> Mailing Address PO BOX 332 <br /> MANTECA, CA 95336 <br /> Care of A&A ROSSI HAY SERVICE <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009948 10,183,053 <br /> Facility Name A&A ROSSI HAY SERVICE <br /> Location <br /> MANTECA, CA 95336 1 <br /> Phone 209-823-3965 <br /> Mailing Address PO BOX 332 <br /> MANTECA, CA 95336 <br /> Care of <br /> Location Code 04- MANTECA Alt Phone <br /> SOS District 003- BESTOLARIDES Fax <br /> APN 19816021 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 AR0016948 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name A&A ROSSI HAY SERVICE (Circle one) <br /> Account Balance as of 4/23/2013: $6,566.10 <br /> (Circle One) <br /> Transfer to Activernactve <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519980 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514106 EE0002646-THUY TRAN Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512236 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PRO509948 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVEPRO515679 EE0002646-THUY TRAN Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0535794 EE0007379-AMANDA BOERTIEN Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PRO531871 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror 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 Ialso mrtify that all operations will be performed in swordanca with all applicable Ordinance Codes andor Standards and State andor <br /> Federal Lewis <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 /> RENS: <br /> Payment Type Check Number Date /�/� Account out: Received by Data l v23 /l 3 <br /> COMMENTS <br /> ��Ir ,"rtr <br /> 0 1 t I ` 1/ \ 1� c� w✓ <br />