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Date run 11/6/2015 4:14:14PN <br /> SAN. UIN COUNTY ENVIRONMENTAL HE4411 DEPARTMENT Report#5029 <br /> Run by Pagel <br /> Facility Information as of 11/6/2015 <br /> Record Selection Crilerra: Facility ID FAD013528 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0010654 New Owner 10 <br /> Owner Name AMERICAN SCISSOR LIFT INC <br /> Owner DBA AMERICAN SCISSOR LIFT INC <br /> Owner Address 3847 DUCK CREEK DR <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> WoWBusiness Phone 209-466-4878 <br /> Mailing Address 3847 DUCK CREEK DR <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0013528 10184393 <br /> Facility Name AMERICAN SCISSOR LIFT INC <br /> Location 3847 DUCK CREEK DR <br /> STOCKTON, CA 95215 <br /> Phone 209-466-4399 x0 <br /> Mailing Address 3847 DUCK CREEK.DR <br /> STOCKTON, CA 95215 <br /> Care of Mike Melthratter <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 002 - MILLER, KATHERINE Fax <br /> APN 17334027 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 AR0022632 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name AMERICAN SCISSOR LIFT INC (Circle One) <br /> Account Balance as of 111612015: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO521081 EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO537759 Ell 1421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0517626 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO517624 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0527951 EE0009000-HARPRIT MATTU Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO532711 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the unders:gned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSlEHD 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 andlor Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 f <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received by <br /> EHD Staff: Date 1 ! Account out: Date 1 1 <br /> COMMENTS: <br /> Invoice#: <br />