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Date run 2/23/2009 11:46:06AI SAN JG' XJIN COUNTY ENVIRONMENTAL HEAI T%J DEPARTMENT Report#5021 <br /> Run by \1112011 Pagel <br /> Facility Information as of 2/23/20"" <br /> Record Selection Criteria: Facility ID FA0005232 <br /> Make changes/corrections in RED ink or pencil. <br /> FIL INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0004097 New Owner ID <br /> Owner Name GONZALES, MARION <br /> Owner DBA TONY GONZALES TRUCKING INC <br /> Owner Address 1855 JACKSON <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-838-3115 <br /> Mailing Address PO BOX 206 <br /> ESCALON, CA 95240 <br /> Care of GONZALES, MARION <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0005232 <br /> Facility Name TONY GONZALES TRUCKING INC <br /> Location 1855 JACKSON AVE <br /> ESCALON, CA 95320 <br /> Phone 209-838-2241 <br /> Mailing Address PO BOX 206 <br /> ESCALON, CA 95240 <br /> Care of GONZALES, MARION <br /> Location Code 06- ESCALON Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 22715406 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name GONZALES, MARION <br /> Title <br /> Day Phone 209-838-3115 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005687 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name TONY GONZALES TRUCKING INC (Circle One) <br /> Account Balance as of 2/23/2009: $-49.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0501817 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 2960-RWQCB SITE PR0527643 EE0006219-LORI DUNCAN Active Y N A 0 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 <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: "$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type <br /> e'�_ ` Check Number Received by <br /> REHS: t,vtn �ytnn.+ v+r— Date / / Account out: f Cm,—Date 2 / / <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />