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Date run 1/28/2008 9:40:01AM, SAN 0- Report COUNTY ENVIRONMENTAL HER ^H DEPARTMENT Reporti150zf <br /> Run by 4006 Pagel <br /> to Facility Information as of 1/28/2008 <br /> Record Selection Criteria: Facility ID FA0005232 <br /> i <br /> i <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> j Owner ID OW 0004097 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 /> I <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 APN:22715406 <br /> BOS District 004-VOGEL, KEN SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> I <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 (Clydeone) <br /> Account Balance as of 1/28/2008: $-294.00 <br /> (Circle One) <br /> Transfer to Active/Inachr <br /> Program/Bement 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 SITE0527643 �E0006219-LORI DUNCAN Active 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 <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 f> Date <br /> Payment Type !/ Check Number 1'77 9 0 Received by <br /> REHS <br /> : Date / / Account out: Date <br /> COMMENTS: <br /> I <br /> I <br /> I <br /> i \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />