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Date run 1112012017 2:38:56P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report #3021 <br />Run by DONNA Pagel <br />Facility Information as of 11120/2017 <br />Record Selection Criteria: Facility ID FA0010041 <br />OWNER FILE INFORMATION Number of facilities for this owner : 1 <br />Owner ID OWQ008041 Case Number: H06315 <br />Owner Name <br />ALGER, BRENT <br />Owner DBA <br />AG -AIR INC <br />OwnerAddress <br />5420 E DODDS RD <br />OAKDALE, CA 95361 <br />Home Phone <br />Not Specified <br />Work]Business Phone <br />209-988-2567 <br />Mailing Address <br />5420 DODDS RD <br />Care of <br />OAKDALE, CA 95361 <br />Care of <br />gg - UNINCORPORATED A <br />FACILITY FILE INFORMATION <br />Facility IDICERS ID <br />FA0010041 10183153 <br />Facility Name <br />AG AIR INC <br />Location <br />18417 E HWY 4 <br />STOCKTON, CA 95215 <br />Phone <br />209-465-5818 x <br />Mailing Address <br />5420 DODDS RD <br />OAKDALE, CA 95361 <br />Care of <br />Brent Alger <br />Location Code <br />gg - UNINCORPORATED A <br />BOS District <br />004 - WINN, CHARLES <br />APN <br />18325012 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN 1 Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0017041 <br />NewAccount ID: <br />Mail Invoices to Account <br />Mail Invoices to: <br />Owner 1 <br />Facility <br />1 <br />Account <br />Account Name AG AIR INC <br />(Circle One) <br />Account Balance as of 1112012017: $535.00 <br />(Circle One) <br />Transfer <br />to <br />Activellnactve <br />ProgramrElement and Description <br />Record ID <br />Employee ID and Name <br />Status <br />New Owner? <br />Delete <br />1921 - HMBP-Reqular-Primary Location <br />PR0521206 <br />EE0008709 - JAMIE LIMA <br />Active <br />Y <br />N <br />A D <br />2221 - USED OIL ONLY - 45 TONSIYR <br />PR0523589 <br />EE0000031 - ELIANNA FLORIDO <br />Active <br />Y <br />N <br />A I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PR0512329 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FI <br />PRO510041 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A I D <br />2830 -AST FAC - SPCC EXEMPT <br />PR0529721 <br />EE0000027 - CINDY VO <br />Inactive <br />Y <br />N <br />A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI <br />PRO534455 <br />Inactive <br />Y <br />N <br />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 facility <br />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 Ordinance Codes andlor Standards and State andlor <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date 1 <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date 1 1 <br />Water System to be TRANSFERED: Amount Paid Date i 1 <br />Payment Type Check Number Received b <br />EHD Staff: Date t 1~i !1Jli Account out: Date <br />COMMENTS: Invoice #: 1?pZoo 7 <br />©Pecc9�-�-1n <br />-Jn CA�1V 0LL. 2221, Gs Q1 11�, GSL W ©wk's, AG A(V- �.© fart r �- lam c{ <br />