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Data run 10114/2011 3:57:19P SAN JC 'ZUIN COUNTY ENVIRONMENTAL HEAT"'H DEPARTMENT Report#5D21 <br /> Run by <br /> Facility Information as of 10114/2DTI Pagel <br /> Record Selection Criteria: Facility ID FA0020794 <br /> Make changes/corrections in RED ink. <br /> FILE INFORMATION <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008182 New Owner ID <br /> Owner Name DONALD LAWLEY CO INC <br /> Owner DBA <br /> Owner Address 2710 LOOMIS RD <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-466-8088 <br /> Mailing Address PO BOX 2778 <br /> LODI, CA 952412778 <br /> Care of LAWLEY, BARBARA <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0020794J AC-(' <br /> Facility Name DON LAWLEY CO INC <br /> Location 1115 BLACK DIAMOND WAY <br /> LODI, CA 95240 <br /> Phone 209-466-8088 <br /> Mailing Address PO BOX 2778 <br /> LODI, CA 952412778 <br /> Care of LAWLEY, BARBARA <br /> Location Code 02- LODI Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 04918009 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name STEVE HAY <br /> Title GENERAL MANAGER <br /> Day Phone 209-466-8088 <br /> Night Phone 209-456-1185 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0037323 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name DON LAWLEY CO INC (Circle One) <br /> Account Balance as of 10/14/2011: $0.00 <br /> (Circle One) <br /> Transfer to Active/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Sta New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO536190 EE0001422-ARIS CACAPIT A 've Y N A U D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPRO536191 EE0001422-ARIS CACAPIT Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/o project specific,PHS/EHD hourly charges associated wgh 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 Ordinate Cortes and/or Standards and <br /> State andfor Federal Laws. <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 /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: (� <br /> (�'�� �4�nR�( _ C��I� (v d�" ETv�y/✓� �l.J ail' tlea ��f,� � � �)"F- <br /> \\eh-env\envision\reports\5021.rpt <br />