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Date run 3/10/2016 11:13:50AI SAN JO. JIN COUNTY ENVIRONMENTAL HEA" J DEPARTMENT Report#5021 <br /> Run by �/ '�.f6/ Pagel <br /> Facility Information as of 3/10/20 <br /> Record Selection Criteria: 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 , L <br /> Mailing Address 2€iEN�, SAP�PD 2, "46 O K4S SoIJ Q 0 <br /> TPR46*, GA-943QA �^ '[ rc,c�f CA 915--224 _ 4?C0 t) � <br /> Care of Trinkle Ag Flying Inc. <br /> Location Code Alt Phone <br /> BOB District Fax <br /> APN 23918005 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026740 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name TRINKLE AG FLYING INC (Circle One) <br /> Account Balance as of 3/10/2016: $518.00 <br /> (Circle One) <br /> Transferto Activennachie <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0522727 EE0000010-PETER LOMBARDI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0538492 EE0001459-VICKI MCCARTNEY Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531896 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACIOIOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,endor project specific,PHSrEHD hourly chargers associated with this facility <br /> or activity will be billed to the party identified as the OWNER on Nis form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and Slate andor <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 <br /> EHD Staff: Date / / Account out: Date 0 / / _I <br /> COMMENTS: l/ <br /> Invoice#: <br />