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Date run 1/29/2014 9:50:46AN SAN JOS' IN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Run by — Pagel <br /> Facility Information as of 1/29/2014 <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 SSN/Fed Tax ID <br /> Owner ID OW0012451 New Owner ID <br /> Owner Name H ANN TRINKLEJOHN E TRINKLE <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 25001 KASSON RD <br /> TRACY, CA 95304 <br /> Care of <br /> Location Code Alt Phone <br /> BOS 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 Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name H ANN TRINKLEJOHN E TRINKLE (Circle One) <br /> Account Balance as of 1/29/2014: $0.00 <br /> (Circle One) <br /> Transferto Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0522727 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531896 Inactive Y N 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 and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / ! <br /> Water System to be TRANSFERED: Amount Paid Date 1 / <br /> Payment Type Check Number —Recorved by <br /> RENS: � _`I T �(�� Date _/7_CT_/ Account out: Date / / <br /> COMMENTS: <br /> �� P <br />