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Report 05021 <br /> EReCom <br /> 1;cnteda: <br /> 2:06:25PA SANJc_ )UIN COUNTY ENVIRONMENTAL HEAHDEPARTMENT Repel <br /> Facility Information as of 11/3/2005 <br /> SelectioFacility ID FA0009315 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION "�� <br /> Owner ID OW0007315 Case Number: H03059 New Owner ID <br /> Owner Name VACCAREZZA, JOHNNY <br /> Owner DBA JOHNNIE'S WELDING <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-887-2919 <br /> Mailing Address 17701 E COMSTOCK RD <br /> LINDEN, CA 95236 <br /> Care of VACCAREZZA, JOHNNY <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009315 <br /> Facility Name JOHNNIE'S WELDING <br /> Location 17701 E COMSTOCK RD <br /> LINDEN, CA 95236 <br /> Phone 209-887-2919 <br /> Mailing Address 17701 E COMSTOCK RD <br /> LINDEN, CA 95236 <br /> Care of VACCAREZZA, JOHNNY <br /> Location Code 99- UNINCORPORATED AREA APN:09118003 <br /> BOS District 004-SEIGLOCK, JACK SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016315 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name JOHNNIE'S WELDING (Circle One) <br /> Account Balance as of 11/3/2005: $770.50 <br /> (Circle One) <br /> Transferto Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO513768 EE0008373-JOHN JACKSON Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511603 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0519541 EEOD00000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO509315 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0523741 EE0003611 -FRANK GIRARDI Active Y N A 1 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 identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Orolnace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S 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 Received by <br /> REHS: Date / /_ Account out: 0T Date <br /> COMMENTS: <br /> C <br /> \Q.QS C��0. `rV� �.Q-�,�,AS --tom r.o \ 6"r•'tiyc `tY� 'W S Ci v..� <br /> v� <br /> \\phs-ehsgl-nt\apps\envisionstreports15021.rpt <br />