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Date ran 4/3/2015 1:08:18PM SAN JOt 'IN COUNTY ENVIRONMENTAL HEAL` pEPARTMENT Report#5021 <br /> Run by )Floe Facility <br /> Facility Information as of 4/3120155 <br /> Record Selection Criteria. Facility ID FA0010250 <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 OW0008250 Case Number: H07471 New Owner ID <br /> Owner Name JOHN KAUTZ <br /> Owner DBA CALIFORNIA HOT WOOD INC <br /> Owner Address 5920 E LIVE OAK RD <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-334-4786 <br /> Mailing Address 5920 E LIVE OAK RD <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010250 10183363 <br /> Facility Name CALIFORNIA HOT WOOD INC <br /> Location 2467 E FRENCH CAMP RD <br /> MANTECA, CA 95336 <br /> Phone 209-333-5480 x0 <br /> Mailing Address 5920 E LIVE OAK RD <br /> LODI, CA 95240 <br /> Care of California Hot Wood, Inc. <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 17710034 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 AR0017250 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name JOHN KAUTZ (Circle One) <br /> Account Balance as of 4/3/2015: $0.00 <br /> (Circle One) <br /> Tranaferto Active/Inactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520185 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO538422 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512538 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510250 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532811 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anNor project specific,PHSEHD hourly charges associated with this facility <br /> or activity will ba billed to the party identified as the OWNER on this forthl also certify that all operations will be performed In accordance with all applicable Ordinance Codes andor Standards and Slate anNor <br /> Federal Laws. <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 by <br /> REHS: Date / / Account out: Date <br /> COMMENTS' <br />