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Date run : 6/13/00 8:07:49AM SAN jWQUIN COUNTY PUBLIC HEALTH SER)&S Report #: 0002 <br />Run by LBROWN Facility Information as of 6/13/00 Page # : 1 <br />Record Selection Criteria: Facility ID FA0010388 <br />Record ID <br />OWNER FILE INFORMATION <br />Owner ID: OW0008388 Case Number: H07978 <br />Owner Name: TODD WETHERELL <br />Owner DBA: <br />Owner Address - <br />Home Phone: Not Specified <br />Work/Bussness Phone: 209-833-1393 <br />Mailing Address: 10250 W LINNE RD <br />Care of - <br />FACILITY FILE INFORMATION <br />Facility ID: FA0010388 <br />Facility Name: OJ COMMERCIAL TRANSPORT INC <br />Location: 10250 W LINNE RD <br />TRACY, CA 95376 20 <br />Phone: 209-833-1393 <br />Mailing Address: 10250 W LINNE RD <br />Care of: TODD WETHERELL <br />Location Code: <br />BOS District: 005 - CABRAL, ROBERT <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID: AR0017388 <br />Mail Invoices to: Account <br />Account Name: OJ COMMERCIAL TRANSPORT INC <br />Account Balance as of 6/13/00: $110.00 <br />Program/Element and Description <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />New Owner ID <br />.�,-� <br />11yot - �1 <br />APN: 253-122-040 <br />SIC Code: <br />New Account ID:: <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />UST(s) Transfer to Acti /Inacty <br />Record ID Employee ID and Name Status Linked New Owner? <br />2220 - SM HW GEN <5 TONS/YR PRO514304 EE0007289 - YOUNGBLOOD Active Y N <br />2399 - UNIFIED PROGRAM FAC STATE SERVICE F PR0510388 EE0000000 - SJC OES Active Y N <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512676 EE0000000 - SJC OES Active Y N <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT. • I, the undersigned owner, operator or agent of same, acknowledge that all site, all rUorproject <br />specific, PHS/EHD hourly charges associated with this facility or activity will be biller[ to the pally identified as the BILLING PARTYon this form. I <br />also certify that all operations will be performed in accordance with all applicable Ordinace Codes ant or Standards and State and/or Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERS <br />Water System to be TRANSFERED: <br />tEHS <br />1.0.0.89.00 <br />Date <br />D: ' $0.00 = Amount Paid Date <br />$150.00 = Amount Paid Date <br />Check Number Receipt Number Receld y <br />Date / _l3 /1-C% Account out: Date /'�21,;,--, <br />