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Date inn 6/8/2005 2:21:45PM SAN 3 �UIN COUNTY ENVIRONMENTAL HE "I DEPARTMENT Repon#5021 <br /> Run by Pagel <br /> Facility Information as of 6/8/2005 <br /> Record Selection Cinema: Facility ID FA0010231 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008231 Case Number: H07415 New Owner ID <br /> Owner Name US RENTALS INC &A/IFI D RENTALS NDI?THGdESTXNC. <br /> Owner DBA UNITED RENTALS INC (STKN) /JAJ/TED /QfnTAI-S <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-544-9000 <br /> Mailing Address 2081 E CHARTER WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010231 <br /> Facility Name US RENTALS INC (STKN) UN/TSD REN 7291-S <br /> Location 2081 E CHARTER WAY <br /> STOCKTON, CA 95205 <br /> Phone 209-948-9241 <br /> Mailing Address 2081 E CHARTER WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code 01 -STOCKTON APN:15514003 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> AccountlD AR0017231 New Account ID <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name US RENTALS INC (STKN) (Clyde One) <br /> Account Balance as of 6/8/2005: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactee <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514240 EE0008844-DINA CRAW Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512519 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PR0514746 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-IDES PRO520172 EE0000000-HAZ MAT SJC IDES Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1184)-obsolete PR0231942 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PR0516877 EE000D451 -STEVE SASSON Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPRO510231 EE0000000-HAZ MAT SJC IDES 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 <br /> facility or activity will be billed to the party idendfied as the OWNER on this form I also candy that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: `�--�^r '_ r Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Type Check Number R d by <br /> REHS: Date_/ / Account out: tD�ate^^ <br /> COMMENTS: REC�U��tt((tt JUN 8 2005 <br /> EP4010NMENT HEALTH <br /> \1phs-ehsgl-nt\apps\envisions\reports\5021.rpt pERMIT/SER\ACES <br />