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Dale run 11/18/2016 9:22:25A SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/18/2016 <br /> Record Selection Criteria: Facility ID FA0021974 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 2 SSN/Fed Tax ID <br /> Owner ID OW0018035 New Owner ID <br /> Owner Name Keith Powell <br /> Owner DBA AMERICAN CRANE RENTAL <br /> Owner Address 17800 S COMCONEX RD <br /> MANTECA, CA 95336 <br /> Home Phone 209-838-8815 <br /> Work/Business Phone 209-838-8815 <br /> Mailing Address PO Box 308 <br /> Escalon, CA 95320 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021974 <br /> Facility Name AMERICAN CRANE RENTAL INC <br /> Location 23584 ARTHUR RD <br /> ESCALON, CA 95320 <br /> Phone 209-838-8815 <br /> Mailing Address PO BOX 308 <br /> ESCALON, CA 95320 <br /> care of POWELL, KEITH <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 22903010 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> contact Name DONNA SUNS <br /> Title ACCOUNTING DEPT <br /> Day Phone 209-652-7849 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0040065 New Account ID: <br /> Maillnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name AMERICAN CRANE RENTAL INC (Circle One) <br /> Account Balance as of 11/18/2016: $0.00 <br /> (Circle One) <br /> Transferto 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 PR0538047 EE0009001 -ELENA MANZO Active Y N A �Z) D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO538158 EE0002622-BENJAMIN ESCOTTO InactivE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT'. I,the undersigned owner,operator or agent of same,acknowledge that all site,andor protect specific PHSrEHD hourly charges associated with this facility <br /> or activity will 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 andor Standards and State andor <br /> Federal I. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Receive P!bIrl <br /> EHD Staff: Date / / Account out: Date 11�l0 <br /> COMMENTS: <br /> IRVOICe III: <br />