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Date run 11/8/2017 2:51:03PIV SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 95021 <br /> Run by Pagel <br /> Facility Information as of 11/8/2017 <br /> Record Selection Criteria: Facility ID FA0010425 <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 OW0008425 Case Number: H08067 New Owner ID <br /> Owner Name Pacific Southwest Container LLC, a Delaware <br /> Owner DBA PACIFIC SOUTHWEST CONTAINER <br /> Owner Address 4530 E LECKRON RD <br /> MODESTO, CA 95357 <br /> Home Phone 209-526-0444 <br /> Work/Business Phone 209-526-0444 <br /> Mailing Address 4530 E LECKRON RD <br /> MODESTO, CA 95357 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0010425 10183549 <br /> Facility Name PACIFIC SOUTHWEST CONTAINER <br /> Location 4343 E FREMONT ST <br /> STOCKTON, CA 95215 <br /> Phone 209-526-0444 x <br /> Mailing Address 4530 E LECKRON RD <br /> MODESTO, CA 95357 <br /> Care of Pacific Southwest Container LLC <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 002 - MILLER, KATHERINE Fax <br /> APN 14328039 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title / <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017425 \1\ New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name PACIFIC SOUTHWEST CONTAI R (Circle One) <br /> Account Balance as of 11/8/2017: $0.00 <br /> (Circle One) <br /> Transferto Acaventactva <br /> Program/Element and Description Record ID Employee ID and Name Status New Ownerl Delete <br /> 1921 -HMBP-Regular-Primary Location PRO520340 EE0008709-JAMIE LIMA Active Y N A - D <br /> 2220-SM HW GEN<5 TONS/YR PR0528554 EE0000031 -ELIANNA FLORIDO Active Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512713 EEo000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0232095 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO510425 EE0000o00-HAZ MAT SJC OES Inactive Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0529235 EE0000031 -ELIANNA FLORIDO Active Y N A©D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0533738 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project speck,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also candy that all operations will be performed in accordance with all applicable Ordinance Codes anNor Standards and State ander <br /> Federal Lewis <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment Type Check Number Received b �f <br /> EHD Staff: Date / /�_Account out: 14 Date <br /> COMMENTS: �K C' � C.— _ 1 O V 2,lnvoice#: <br />