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Date run 30/2007 11:04:14AM SAN JO, 'JIN COUNTY ENVIRONMENTAL HEAI—'-!DEPARTMENT Report#5021 <br /> Run W, 406t".01Paget <br /> Facility Information as of 3/5/201jT' <br /> Record Selection Criteria: Faci ity ID FA0010825 <br /> Make changes/corrections In RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008822 New Owner ID <br /> Owner Name VINTAGE PRODUCTION CA LLC <br /> Owner DBA <br /> Owner Address PO BOX 459 <br /> WOODLAND, CA 95776 <br /> Home Phone Not Specified <br /> Work/Business Phone 916-661-3966 <br /> Mailing Address PO BOX 609 <br /> RIO VISTA, 945711230 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010825 <br /> Facility Name VINTAGE PRODUCTION CA LLC <br /> Location .2147 W BOWMAN RD <br /> STOCKTON, CA 95206 <br /> Phone 707-374-6428 <br /> Mailing Address 9600 MING AVE STE 300 <br /> BAKERSFIELD, CA 93311 <br /> Care of ACCOUNTS PAYABLE <br /> Location Code 99- UNINCORPORATED AREA APN 191-140-01 <br /> BOS District 003-MOW,VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017825 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name VINTAGE PRODUCTION CA LLC (Circle One) <br /> Account Balance as of 3/5/2007: $230.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> ProgramfElement and Description Record ID Employee ID and Name Status New Owned Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO517955 EE0000753-WILLIE NG Active Y N A 1 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO513113 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPR0510825 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknovuedge that all sue,and/or project spectra;,PHS/EHD hourly charges associated wit,this <br /> really 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS 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 Received by <br /> REHS: Date / ! Account out: Date / / <br /> COMMENTS: <br /> D <br /> ✓ltic� ? ��r✓0.-� 7 <br /> C, Ate' <br /> V74h7 <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />