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Datemn 9/15/2009 10:06:51AI SAN JU 1UIN COUNTY ENVIRONMENTAL HEA' "I DEPARTMENT Repos W21 <br /> Pon by Facility Information as of 9/15/2b sc( Pagel <br /> Record Selection Creeds: Facility ID FA0010111 <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 OW0008111 New Owner ID <br /> Owner Name VALLEY TRANSPORT SERVICES INC <br /> Owner DBA YELLOW CAB <br /> Owner Address 5000 S AIRPORT WAY 205 <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <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 YELLOW CAB <br /> Location 7030 S C E DIXON ST <br /> STOCKTON, CA 95206 <br /> Phone 209462-8700 <br /> Mailing Address 6500 LINDBERGH ST <br /> STOCKTON, CA 952064928 <br /> Care of <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 17726026 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone /7,44) <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017111 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name YELLOW CAB (Circle One) <br /> Account Balance as of 9/15/2009: $0.00 <br /> (Circle One) <br /> ve <br /> Program/Element and Description Record ID Em ID and Name Status Transfer to Activellete <br /> Employee New Owneh Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514174 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512399 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO520874 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0510111 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the urMersigned owner,operator or agent of same,acknowledge that all site,andlor project spectra,PMS/EMD hourly charges associated with this <br /> facility or activity will be Wait to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance in all applicable Ordinace Codes and/or Standards and <br /> Stale amilor Federal Laws, <br /> APPLICANTS SIGNATURE: Date / I <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 Recall ell J� <br /> REHS: Account out: w Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />