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Date run 3/1/2013 9:50:25AM SAN JC UIN COUNTY ENVIRONMENTAL HEA I DEPARTMENT Report#5021 <br /> Run by I..( Pagel <br /> Facility Information as of 3/1/2013 <br /> Record Selection Cn ena: Facility ID FA0010111 <br /> Make changes/corrections in RED Ink. 7 <br /> INFORMATION CHANGE(date) �V <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008111 New Owner ID <br /> Owner Name VALLEY TRANSPORT SERVICES INC <br /> Owner DBA <br /> Owner Address 6500 LINDBERGH ST <br /> STOCKTON. CA 952064928 <br /> Home Phone 209-327-2500 <br /> Work/Business Phone 209462-8700 <br /> Mailing Address 6500 LINDBERGH ST <br /> STOCKTON, CA 952064928 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010111 <br /> Facility Name VALLEY TRANSPO SERVICES INC <br /> Location 7030 S C E DIXO ST <br /> STOCKTON, 95206 <br /> Phone 209-462-87 <br /> Mailing Address 6500 LI BERGH ST <br /> STO ON, CA 952064928 <br /> Care of <br /> Location Code g -UNINCORPORATED P Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 17726034 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FI INFORMATION n d <br /> Account) AR0017111 P1 M vUe. Q G�o New Account ID: : <br /> Mail Invoices t Mail Invoices to: Owner / Facility / Account <br /> Account Name VALLE PORT SERVICE INC !` (ClrcleOne) <br /> Account Balance as of 3/1/201 . $563.00 /(t K, DV Z�Z u <br /> �- (CIrcAe one) <br /> Transfer toActiveffnachn, <br /> PrograMElament and Description Record ID Employee ID and Name Status Now Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520874 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514174 EE0002670-MUNIAPPA NAIDU Active Y N I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512399 EE0000000-HAZ MAT SJC OES Inactive Y N I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0510111 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0533398 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project speac,PHSIEHD hourly charges esscclet with this facility <br /> Or activity,will be billed to the party ider i(ed as the OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes endo'Standards rd State ands <br /> Federal Laws � � /5 t / /y1 1 j /-s 2 * 0' <br /> APPLICANTS SIGNATURE: IyrJ I4 - l I Date `/ v/ / <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 b <br /> REHS: Date / / Account out: Date 1 N ✓ `,�/•t <br /> COMMENTS: �Lj <br />