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Date run 2/13/2007 9:19:03AN SAN JOk—'JIN COUNTY ENVIRONMENTAL HEAL-" DEPARTMENT Report#5021 <br /> Run by 4006Paget <br /> -� Facility Information as of 2/13/200710' <br /> Record Selection Criteria: Facility ID FA0010824 <br /> Make changes/corrections in RED ink or pencil. <br /> ° INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008822 Case Number: H08817 New Owner ID <br /> Owner Name VINTAGE PRODUCTION CA LLC <br /> Owner DBA <br /> Owner Address PO BOX 459 <br /> WOODLAND, CA 95776 <br /> Home Phone Not Specified <br /> Work/BusinessPhone 916-661-3966 <br /> Mailing Address PO BOX 609 <br /> RIO VISTA, 945711230 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010824 <br /> Facility Name VINTAGE PRODUCTION CA LLC <br /> Location 12350 S CROCKER RD <br /> STOCKTON, CA 95206 n <br /> Phone 707-374-6428 A�-tro A-1 Nn J' t <br /> Mailing Address PQ-B0 )(--2565 -1 (c "`1n1 �r /'IVa 57F 31)Z <br /> ADDISG+11-, <br /> 1) lZ- <br /> ADDiSgA1,x`565--_ <br /> Care of VINTAGE PRODUCTION CA LLC <br /> Location Code 99 - UNINCORPORATED AREA APN 191-040-02 <br /> BOS District 003 -MOW, VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017824 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name VINTAGE PRODUCTION CA LLC (Circle One) <br /> Account Balance as of 2/13/2007: $230.00 <br /> (arae On) <br /> Transferto Activennac e <br /> Program0ement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0517954 EE0000753-WILLIE NG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO513112 EE00o0000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPRO510824 EE00o0000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owmer,operator or agent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly charges associated with this <br /> facility or activiy,will be billed to the parry identified as the OWNER on this forth. I also certify that all operations will be performed in accordance vnth all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Pte- `-��� VI f✓' ^—�12� Date a—/ <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: Date .2-113 /07 <br /> COMMENTS. <br /> \\phs-ehsq I-nt\apps\e nvisions\repons\5021.rpt <br />