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Date run ,1,5/6/2013 2:59:54PM SAN JODUIN COUNTY ENVIRONMENTAL HEA*DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 5/6/2013 <br /> Record Selection Criteria: Facility ID FA0016433 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSNI Fed Tax ID <br /> Owner ID OW0013305 New Owner ID <br /> Owner Name STOCKTON WHOLESALE LUMBER <br /> Owner DBA <br /> Owner Address 2908 BOZZANO RD <br /> STOCKTON, CA 95215 <br /> Home Phone 209-931-7884 <br /> Work/Business Phone Not Specified <br /> Mailing Address 2908 BOZZANO RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATIONinI � I' /'� <br /> Facility lD/CERS ID FA0016433 �,� �"�la t..�-- ply, cy__C�e. <br /> Facility Name STOCKTON WHOLESALE LUMBER <br /> Location 2908 BOZZANO RD <br /> STOCKTON, CA 95215 <br /> Phone 209-931-7884 <br /> Mailing Address 2908 BOZZANO RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> SOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 10111054 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 AR0028909 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name STOCKTON WHOLESALE LUMBER (Circle One) <br /> Account Balance as of 5/6/2013: $0.00 <br /> Z I (Circle One) <br /> Transfer to Active/Inactve <br /> Progra"Element and Description 1� Record ID Employee ID and Name Status New Owner? Delete <br /> 4740-WASTE TIRE SITE-EXEMPT PR0524503 EE0004045-TED TASIOPOULOS Inactive Y N 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 <br /> or activity will be billed to the party identified as the OWNER on this form I also codify that all operations will be performed in accordance with all applicable Ordinance Codes ardor Standards and State and'or <br /> Federal Laws, <br /> APPLICANT'S SIGNATUF Date <br /> Richard M. Montiel Date <br /> Program Records a be TF <br /> Stockton Site Manager Date / / <br /> Water System to be TRAP <br /> Payment Type iFIOMLIURS M: (209) 401-4746 Received by <br /> REHS: O: (209) 931-4125 Date_/ / <br /> COMMENTS: F: (209) 9314179 <br /> L) richard.montiel@agroliquid.com <br /> (5l 2908 Bozzano Rd.Stockton,CA 95215 <br /> w rr <br />