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Date run 2/5/2007 8:05:55AM SAN JOA COUNTY ENVIRONMENTAL HEALOEPARTMENT Report#5021Pagei <br /> Ru,by , <br /> Facility Information as of 2/5/2007 <br /> Record Selection Criteria: FacilityID FA0001492 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(dale) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0001163 New Owner ID <br /> Owner Name WASTE MANAGEMENT OF CALIF INC <br /> Owner DBA <br /> Owner Address 2769 W HATCH RD <br /> MODESTO, CA 95358 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-538-2210 <br /> Mailing Address 2769 W HATCH RD <br /> MODESTO, CA 95358 <br /> care of WASTE MANAGEMENT OF CALIF INC <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001492 <br /> Facility Name CAL STATE RENTALS&SALES <br /> Location 2150 E FREMONT ST <br /> STOCKTON, CA 95205 <br /> Phone 209-538-2210 qn — 5 // \\ <br /> Mailing Address 2�D 3d SMd itis `^ <br /> MOST__ rC� ° o���R � LJ o � a <br /> Care of WASTE MANAGEMENT OF CALIF INC <br /> Location Code 01 -STOCKTON APN 15313008 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0001491 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CAL STATE RENTALS &SALES (Circle One) <br /> Account Balance as of 2/5/2007: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PRO420123 EE0005944-MICHAEL ESCOTTO Inactive Y N A I D <br /> 4244-PUMPER TRUCK PR0420146 EE0007379-AMANDA BOERTIEN Active Y N A I D <br /> 4244-PUMPER TRUCK PR0420147 EE0007379-AMANDA BOERTIEN Active Y N A I D <br /> 4244-PUMPER TRUCK PR0504927 EE0005944-MICHAEL ESCOTTO Inactive Y N A I D <br /> 4244-PUMPER TRUCK PR0506748 EE0005944-MICHAEL ESCOTI-O Inactive Y N A I D <br /> 4244-PUMPER TRUCK PRO518834 EE0007379-AMANDA BOERTIEN Active Y N A I D <br /> 4244-PUMPER TRUCK PR0518835 EE0007379-AMANDA BOERTIEN Active Y N A I D <br /> 4244-PUMPER TRUCK PR0518836 EE0007379-AMANDA BOERTIEN Active Y N A I D <br /> 4246-PUMPER YARD PR0420050 EE0007379-AMANDA BOERTIEN Active Y N A I D <br /> 4255-CHEMICAL TOILETS PR0420095 EE0007379-AMANDA BOERTIEN 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 andor Federal Laws. <br /> APPLICANTS SIGNATURE: S 2G \MLI\ 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 Check Number Received by <br /> REHS: Date / / Account out: Cr Date__/--0 / 0 <br /> COMMENTS: <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />