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I <br /> Date run 11130!2015 8:14:16A SAN J�2UIN COUNTY ENVIRONMENTAL HE),' I DEPARTMENT Report#5021 <br /> Run byPagel <br /> Facility Information as of 11/30/2015 <br /> 3 <br /> Record Selection Criteria: Facility ID FA0010161 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN I Fed Tax ID <br /> Owner ID OW0008161 Case Number: H06972 New Owner ID <br /> Owner Name Travis Nixon <br /> Owner DBA STOCKTON TRUSS INC <br /> OwnerAddress 4408 E FREMONT ST <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> WorklBusiness Phone 209-464-7358 <br /> Mailing Address 4408 E FREMONT ST <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID!CERS ID FA0010161 10183279 <br /> Facility Name STOCKTON TRUSS INC <br /> Location 4408 E FREMONT ST <br /> STOCKTON, CA 95215 <br /> Phone 209-464-7358 x0 <br /> Mailing Address 4408 E FREMONT ST <br /> STOCKTON, CA 95215 <br /> Care of Travis Nixon <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 002 -MILLER, KATHERINE Fax <br /> APN 14332062 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone J <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017161 New Account ID: <br /> Mail invoices to Account Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name STOCKTON TRUSS INC (Circle One) <br /> Account Balance as of 1113012015: $0.00 <br /> (Circle One) <br /> Transfer to ActiveAnactve I <br /> Program/Element and Description Record 1D Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PRO520110 EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512449 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FE PRO510161 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0524274 EE0002622-BENJAMIN ESCOTTO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE PR0531379 Inactive 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 speck,PHSIERD 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 andror Standards and State and'or <br /> Federal Laws_ <br /> APPLICANTS SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date !. 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 / <br /> Payment Type Check Number Received by <br /> EHD Staff: Date 1 1 Account out: Date ! ! <br /> COMMENTS: Invoice#: <br />