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Data run 7/21/2009 8:56:50AK SAN J QUIN COUNTY ENVIRONMENTAL HEF -°_I DEPARTMENT Report 05021 <br /> Run by �✓ Paget <br /> Facility Information as of 7/21/2009 <br /> Record Selection Criteria: Facility ID FA0018219 <br /> Make changes/corrections In RED ink. <br /> INFORMATION CHANGE(date) <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 1 o5� r Tr—r�-�RD // -2�`` _ <br /> LOCKEFORD, CA 95237 .40 ��Z_ <br /> Home Phone 299-7-27-66,31 <br /> Wori Business Phone 2p9_7Q.7 5e5g m� 7 <br /> Mailing Address PO BOX 400 r Wk r L7 450 I <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018219 <br /> Facility Name D H WINN TRUCKING INC <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 A Ah Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 05132010 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DH WINN <br /> Title <br /> Day Phone 209-727-5531 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032059 New Account 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 7/21/2009: $2,195.00 <br /> (Circle One) <br /> Transferto Activelinactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PRO526899 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO527523 Active Y N A I D <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVEPRO526901 EEOD01422-ARIS CACAPIT Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0526900 EES555555-Garrett Alias-Backus Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned uwmr,operator or agent M same,acknaMedge mat all site,andlor project spec,PHS/EHD hourly charges associated with this <br /> facility or activity,will be billed to the party identified as the OWNER on this form. I also cenify that all operations will be performed in accordance with all applicable Ordmace Codes andlor Standards and <br /> Stale anNor 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 Recei y� � <br /> REHS: Date / / Account out: Date / I <br /> COMMENTS: <br /> \\eh-env\envisionVeports\5021.rpt <br />