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08/27/2008 14:08 2094640138 ENVIRONMENTAL HEALTH PAGE 01/01 <br /> PM <br /> e0t.rur-12 noon 8:33:29AN SAN Je- `,..N COUNTY ENVIRONMENTAL HEP - rH L.,,.ARTMENT pa"I `5"2' <br /> RM by aO•� <br /> Facility Information as of 7/22/208 <br /> Rerxtrd selection Criteria: ' <br /> FAQO10551 <br /> Malo changeskDomtoctlons In RED Ink er tat. <br /> I CHANGE(date) <br /> NER ANGE dabs) Q <br /> OWNER FILE INFORMATION SSN I Fed Tax IDI -d 4.3 0 14 <br /> Owner 10 OW0008551 Case NumW. !-108321 New Owner 10 <br /> Owner Name R MCCULLOUGH GG fes{`' o Vk <br /> Owner Dei R&R MCCULLOUGH MOBILE REPAIR t <br /> 1 Owner Address 177 KELLY ST �� <br /> LODI, CA 952403107 SZ3 N.. c+cr�w�c.ti1D f <br /> Home Phone Not Specified �o I _ q 57K 0 <br /> WoriV13uslness Ptwn9 209-334-4305 2008 <br /> Mailing Address 177 KELLY ST <br /> LODI,CA 952403107 d QUIN Cot INTy <br /> Care of ♦ F �?Sx EN SERVICES <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010551 <br /> Facility Name R&R MCCULLOUGH MOBILE REPAIR -011 ����-GS. KC.- <br /> Location 5231 N SACRAMENTO ST <br /> LODI,CA 95240 <br /> Phone 209.334-4305 Z04 2 3 V b- 4 <br /> Mailing Address 177 KELLY ST P,U• 130X �at 52-F <br /> LODI,CA 952403107 L4c�r� rc L 45Z$ <br /> Care of <br /> Lotion Code 02-LOCM Alt Phone <br /> li District 004-VOGEL. KEN Fox § e. <br /> APN 041-210-22-0 EMall• ArtJoEcr1�, p <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION '4"�`�'�u t -r <br /> Contact Name e,i e- �' �V t7�ii 4S <br /> Title t'-+".64-& V41L& <br /> Day Phone X09 -14.6 -4vf b <br /> Night Phone zoo yt0 Lt j5?, <br /> ACCOU14TS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017551 New account ID, <br /> Melt Invoices to Facility Mai Invoices to- Owner aciity Account <br /> Account Name RSR MCCULLOUGH MOBILES REPAIR <br /> Account Balance as of 712212008' /�o� ,,7f Ali �7 <br /> T187{AF to >iCtIvii <br /> ProarwrvEremenl and Dasertp~ Racord ID Empi" ID end-Nw"s Status New Omar`? rinkts <br /> 2220-SM HW GEN e5 TONSlYR PRO517946 EEDW1422-ARIS CACAPIT Inactive C59 N 1 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIIPRO512839 EE0040000-HAZ MAT SJC OES Inactive Y N A 1 D <br /> 2226 Cali PROGRAM PROS 14804 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OFS PRO520417 E€0040000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO510551 EEOOOOOOO-HAZ MAT SJC OES Intactive Y N A 1 D <br /> BILLING GMM COMPLIANCE ACKNOWt-EC+GEMENT, T.the undarsfgned GWW,operator Dr d same,acknoMedge nkat all sit*,ertalor proieet cpedee.PNSf£ND hourly charges aasoWled Jth INS <br /> tachy or ecevlty will be blood to the Party Idi as the OWNER an WS foram, I also carreyr msI I operations YA be performed In ecoordar"with an epVRGWe Ordmnee Cede?endror Standai and <br /> State end/or Federal Lhw. <br /> APPLICANTS SIGNATURE: Dat4 <br /> Progrgm Records to he TRANSFERED: `$20.00= Amount Paid Date 1 ! <br /> Water System to be TRANSFEREp; '5172.00 n Amount Paid Date I ! <br /> Payment Type Checli Number R <br /> RENS: Dare 1 1 a Aecount out. Date ! 1� <br /> COMMENTS! <br /> 11Dh5 ehsal nflrtooR�Prnis nnalrannn4t5n71 mt <br />