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Report 115027 <br /> ERun <br /> mn :1113:01201:510:5:1:29) ::SAN JOIN COUNTY ENVIRONMENTAL HE <br /> DEPARTMENT Pagel <br /> y Facility Information as of 11130/2015 <br /> Recortl Selection Criteria: Facility ID FA0010313 <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/Fed Tax ID <br /> Owner ID oW0008313 Case Number: H07709 New Owner ID <br /> Owner ame SCHWANS HOME SERVICE INC <br /> ownerJDBA SCHWAN'S HOME SERVICE INC <br /> owner Address 115 W COLLEGE DR <br /> MARSHALL, MN 562581796 <br /> Home Phone Not Specified <br /> Work/Business Phone 507-537-8322 <br /> Mailing Address 115 WEST COLLEGE DRIVE <br /> Marshall, MN 56258 <br /> Care of <br /> FACILITY FILE INFORMATION 10155367 <br /> Facility ID/CERS ID FA0010313 <br /> Facility Name Schwan's Home Service Inc-Manteca, CA <br /> Location 575 INDUSTRIAL PARK DR <br /> Manteca, CA 95337 <br /> Phone 209-824-3011 x <br /> Mailing Address 115 WEST COLLEGE DRIVE <br /> Marshall, MN 56258 <br /> Care of SCHWAN'S HOME SERVICE INC Alt Phone <br /> Location Code 04-MANTECA Fax <br /> BOS District 005- ELLIOTT, BOB Email: <br /> APN 22119058 <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION New Account ID: <br /> AccountlD AR0017313 Mail Invoices to: Owner / Facility I Account <br /> Mail Invoices to Account (circle one) <br /> Account Name Randy Sharbono <br /> Account Balance as of 11/30/2015: $0.00 (circle one) <br /> Transfer to Activennacwe <br /> Record ID Employee ID and Name <br /> Status New OwneR Delete <br /> Program/Element and Description Active Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PR0520306 EE0000010-PETER LOMBARDI Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512601 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO610313 EE0000000-HAZ MAT SJC OI Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0635380 EE0002622-BENJAMIN ESCOTTO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532885 and'or ro acts ecifc,PHSIEHD hourly charges associated with this facility <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,opemlor or agent of same,acknowledgethat accoile, p 1 P <br /> or activity will be billed to the party identified as the OWNER on this form 1 also certify that all operations will be performed in accomanoe with all applicable Ordinance Codes andror Standards end State and'or <br /> Federal Laws. <br /> Date _/—/— <br /> APPLICANT'S SIGNATURE: <br /> 25.00= Amount Paid Date <br /> Program Records to be TRANSFERED: $ Amount Paid Date_/—/— <br /> Water System to be TRANSFERED: Received by <br /> Payment Type �Check Number Account out: Date <br /> EHDStaff: Date_/—/_ <br /> Invoice#: <br /> COMMENTS: <br />