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Date run 8/23/2018 8:16:06AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/23/2018 <br /> Record Selection Criteria: Facility ID FA0009948 <br /> Make changesicorrections 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 OW0007948 Case Number: H05977 New Owner ID <br /> Owner Name Albert Rossi <br /> Owner DBA <br /> Owner Address 299 N AIRPORT WAY <br /> MANTECA, CA 95336 <br /> Home Phone 209-609-6954 <br /> Work/Business Phone 209-823-3965 <br /> Mailing Address 299 N.Airport Way <br /> Manteca, CA 95337 <br /> Care of ALBERT ROSSI TRUCKING LLC <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009948 10734718 <br /> Facility Name Albert Rossi Trucking LLC <br /> Location 299 N Airport Way <br /> Manteca, CA 95337 <br /> Phone 209-609-6954 x <br /> Mailing Address 299 N.Airport Way <br /> Manteca, CA 95337 <br /> Care of Albert Rossi Trucking LLC <br /> Location Code 04 - MANTECA Alt Phone <br /> BOS District 003 - BESTOLARIDES, STEVE Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016948 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Albert Rossi Trucking LLC (Circle One) <br /> Account Balance as of 8/23/2018: $11,055.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0519980 EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514106 EE9999997-TWO VACANT2 Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512236 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0509948 EE0000000-HAZ MAT SJC OES InactiVE Y N A I D <br /> aP3IH5t-AST FAC 10 K-</=100 K GAL CUMULATIVE PR0515679 EE9999997-TWO VACANT2 Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0535794 EE0007379-AMANDA BOERTIEN InactiVE Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0531871 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 specific,PHS/EHD 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 and/or Standards and State andlor <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 y <br /> EHD Staff: Psc,r v vGICC" Date�_/ Z3 / /!� Account out: Date /�/� <br /> COMMENTS: ���•n�e f ��cfc,vYElew►en� Code f10.1 43d -'a x2831 fr Sete ✓*sl'f <br /> If1V01Ce#: <br /> on 81-731/8 anG/ Nn''kP -Spfcfip1� repay ryarvt a017, plus Zal-7 ftKs su;k-) fle,/. <br />