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Date run 2/19/2014 9:26:67AR <br />Run by <br />Record Selection Criteria: Facility ID <br />SAN JCWJIN COUNTY ENVIRONMENTAL <br />Facility Information as of 2/19/2014 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0007636 Case Number: H05028 <br />Owner Name <br />CLIFFORD C HAHN <br />Owner DBA <br />HAHN TRACTOR CO INC <br />Owner Address <br />1777 S ARGONAUT ST <br />PO BOX 2167 <br />STOCKTON, CA 95206 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-944-0743 <br />Mailing Address <br />PO BOX 2167 <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />STOCKTON, CA 95201 <br />Care of <br />Inactive <br />FACILITY FILE INFORMATION <br />Facility lD/CERS ID FA0009636 10,182,815 <br />Facility Name <br />HAHN TRACTOR CO INC <br />Location <br />1777 S ARGONAUT ST <br />to <br />New Omer? <br />STOCKTON, CA 95206 <br />Phone <br />209-944-0743 x0 <br />Mailing Address <br />PO BOX 2167 <br />N <br />STOCKTON, CA 95201 <br />Care of <br />Location Code 01 - STOCKTON <br />BOIS District 001 - VILLAPUDUA <br />APN 16320020 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0016636 <br />Mail Invoices to Facility <br />Account Name HAHN TRACTOR CO INC <br />Account Balance as of 2/19/2014: $56-90� WA I Ir. <br />Make changesicorrections In RED Ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN /Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax _ <br />EMail : <br />Report#5021 <br />Pagel <br /># <br />1 1�- <br />rr I <br />Employee ID and Namer <br />Statue <br />to <br />New Omer? <br />1921 <br />1921 - HMBP-Regular-Primary Location <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />rri,..ie n„er <br />Program/Element and Description <br />Record ID <br />Employee ID and Namer <br />Statue <br />to <br />New Omer? <br />1921 <br />1921 - HMBP-Regular-Primary Location <br />PR0519789 <br />EE0009817 - ROBERT LOPEZ <br />—ACHVe- <br />Y <br />N <br />2220 - SM HW GEN <5 TONS/YR <br />PRO528673 <br />EE0002646 - THUY TRAN <br />-Aehvr <br />Y <br />N <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PRO511924 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />2381 - UST FACILITY (BEFORE 1/84) - obsolete <br />PR0501908 <br />EE0000451 - STEVE SASSON <br />Inactive <br />Y <br />N <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F <br />PR0509636 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />2840 - AST EXEMPT FAC < 1,320 GAL <br />PRO528672 <br />EE0002646 - THUY TRAN <br />-Aelive,l <br />Y <br />N <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG <br />PR0533507 <br />Inactive <br />Y <br />N <br />(Circle One) <br />Active/lnactve <br />Delete <br />A I D <br />A D <br />A D <br />A I D <br />A I D <br />A U D <br />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 or i <br />be billed to the party identified as the OWNER on this forth. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes anclor Standards and State ander Federal Laws. <br />APPLICANTS SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: <br />" $25.00 = <br />Amount Paid Date <br />Water System to be TRANSFERED: <br />_/_/_ <br />Amount Paid Date / <br />/ <br />Payment Type Check Number <br />3—/z•J <br />Recei <br />REHS: <br />ate_/_/ <br />Account out: Date_/�_/ <br />COMMENTS: c-wi�4 <br />f <br />