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Date run 5/6/2016 2:43:43PM SAN JO IIN COUNTY ENVIRONMENTAL HEAL" DEPARTMENT Report 05021 <br /> Run by , `,/ Paget <br /> Facility Information as of 5/6/2016 <br /> Record Selection Caters. Facility ID FA0015498 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 SSN/Fed Tax ID <br /> Owner ID OW0012451 New Owner ID <br /> Owner Name Charles Proctor <br /> Owner DBA TRINKLE AG FLYING INC <br /> Owner Address 25001 KASSON RD <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-835-2838 <br /> Mailing Address 25001 KASSON RD <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0015498 10184967 <br /> Facility Name TRINKLE AG FLYING INC <br /> Location 25001 KASSON RD <br /> TRACY, CA 95304 <br /> Phone 209-835-2838 x0 <br /> Mailing Address 27460 KASSON RD <br /> TRACY, CA 95304-8001 <br /> Care of TrinkleAg Flying Inc. <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 23918005 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION y� <br /> Contact Name \q \J' <br /> Title AV �J N <br /> Day Phone (� C-k <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026740 !� �\ New Account ID: <br /> Mail Invoices to Accountv , <br /> Mail Invoices to: Owner / Facility / Account <br /> Account Name TRINKLEAG FLYING INC (� (Circle One) <br /> Account Balance as of 5/6/2016: $758.00 <br /> (Circle One) <br /> Transfer to Activennactse <br /> Program/Element and Description Record ID Employee ID and Name Status New OwneR Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0522727 EE0000010-PETER LOMBARDI Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PR0538492 EE0001459-VICKI MCCARTNEY Active Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO531896 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. L the undersigned owner,operator or agent of same,acknowledge that all site,anclor project specaic,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party identhed as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State sector <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment Type Check Number Received by ,I" <br /> EHD Staff: Mat A rl-A C 4 Date 5 / If / l 6 Account out: Date <br /> COMMENTS: <br /> R11 haz4rVkt�a W44fei a C{�py,Il s 1Invgicea <br /> ,b4e*1 re m omit-) T-rbm -4L e. fre <br /> Tr �e-,-+ <br /> wewnl <br /> , saLa / ece +, be1�S}'cto�IA Fix• G eSo� <br />