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Date n2/8/2011 2:44:11 PA 'SAN Jr UIN COUNTY ENVERONMENTAL HE/ 3 DEPARTMENT <br /> Run by Report a5021 <br /> Facility Information as of 12/8/222 Pagel <br /> Retard Selection Criteria: Facility ID FA0018219 <br /> Make changeslcorrections in RED Ink. <br /> INFORMATION CHANGE(date) I Z " 1- <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002849 New Owner ID <br /> Owner Name WINN, D H <br /> Owner DBA DH WINN TRUCKING INC <br /> Owner Address 12505 E BRANDT RD n <br /> LOCKEFCA 95237 <br /> Home Phone 209-727-56085608 <br /> WorkBusiness Phone 209-727-5531 n <br /> Mailing Address PO BOX 400 <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018219 h <br /> Facility Name D H WINN TRUCKING INC a�j✓✓✓ <br /> Location 12505 E BRANDT RD <br /> LOCKEFORD, CA 95237 _ <br /> Phone 209-727-5531 _ <br /> Mailing Address PO BOX 400 _ <br /> LOCKEFORD, CA 95237 _ <br /> Care of WINN, D H <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN F. <br /> APN 05132010 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DH WINN <br /> Title <br /> Day Phone 209-727-5--- <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032059 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name D H WINN TRUCKING INC (Circle One) <br /> Account Balance as of 12/8/2011: $5,532.00 <br /> (Clyde One) <br /> Transfer to Active/Inecbie <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> SM HW GEN<5 TONS/YR PRO526899 EE0001422-ARIS CACAPIT Active Y N A 0 D <br /> 2244-PACT TRANSFER RECORD-OES PR0527523 Inactive Y N A I D <br /> P -AST FAC 10 K-U=100 K GAL CUMULATIVEPRO526901 EE0001422-ARIS CACAPIT Active Y N A (T> D <br /> -WASTE TIRE SITE-EXEMPT PRO526900 EE0002622-BENJAMIN ESCOTTO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0532979 Active 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 spec,PHS/EHD hourly charges associated wah this <br /> . 4 or sOWity 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 /> St a andror Federal Laws. <br /> C �Nac <br /> APINT'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 11gCyTheCk Number Received by <br /> REHS: t"1' DateAccount out: Date_/ / <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />