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Report k5021 <br /> Date run 6122!2010 1.1:18:22AI SAN ji UIN COUNTY'ENVIRONMENTAL HE DEPARTMENT. Paget <br /> Run by Facility Information as of 6/22/2010 <br /> Record Selection Criteria: Facility ID FA0010425 �r <br /> Make changeslcorrections in RED ink. <br /> —�—~ INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN I Fed Tax lD <br /> Owner ID OW0008425 Case Number: H08067 New Owner ID <br /> Owner Name PROACTIVE NORTHERN CONTAINER <br /> Owner DBA <br /> Owner Address 4343 E FREMONT ST <br /> STOCKTON, CA 95215 <br /> Home Phone 209-546-0111 <br /> work/Business Phone 209-373-2900 <br /> Mailing Address 4343 E FREMONT ST <br /> STOCKTON, CA 95215 <br /> Care of HARTOG, GARY <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0010425 <br /> Facility Name PROACTIVE NORTHERN CONTAINER <br /> Location 4343 E FREMONT ST <br /> STOCKTON, CA 95215 <br /> Phone 209-546-0111 <br /> Mailing Address 4343 E FREMONT ST <br /> STOCKTON, CA 95215 <br /> Care of HARTOG, GARY Alt Phone <br /> Location Code 99-UNINCORPORATED A <br /> BOS District 002- RUHSTALLER, LARRY Fax <br /> APN 14328039 EMaiI: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JOE BILLETT <br /> Title PRINT PRODUCTION MGR <br /> Day Phone 209-546-0111 <br /> Night Phone 209-948-0142 xFAX <br /> ACCOUNTS RECEIVABLE FILE INFORMATION New Account ID: <br /> Account lD AR0017425 i Mail Invoices to: Owner I Facility I Account <br /> Mail Invoices to Facility I (Circle One) <br /> Account Name PROACTIVE NORTHERN CONTAINER <br /> Account Balance as of 612212010: $0.00 (Circle One) <br /> Transfer to AcWellnactve <br /> New Owner? Delete <br /> ProgramlElement and Description Record ID Employee ID and Name <br /> Status <br /> Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0528554 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512713 EE0000000-HAZ MAT SJC OES e <br /> ActiveY N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO520340 Y N A I D <br /> )_13$I-UST FACILITY(BEFORE 1184)-obsolete PR0232095 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> '2399-UNIFIED PROGRAM FAC STATE SURCHARPRO510425 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2831 -AST FAC >1=1,320-<10 K GAL CUMULATNPR0529235 EE0009488-JEFFREY WONG AActive Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0533738 <br /> facility or activity wN bCOMPLIANCE <br /> billed to the party identified as the OWNER an this forowner.I also certify that all operations be performedge ed ed n accordance project:all site,andfor all applicable <br /> rOdinEHD fiace Courlyodes andlor charges associated <br /> andardstandil <br /> State andlor Federal Laws. <br /> Date ! ! <br /> APPLICANT'S SIGNATURE: <br /> Amount Paid Date ! I <br /> Program Records to be TRANSFERED: '$20'00 Amount Paid Date ! I <br /> Water System to be TRA SFERED: '$372.00= Received by <br /> Payment Type �CheckNumber <br /> RENS: <br /> Date I I Account out: Date—/—/ <br /> COMMENTS: <br /> Ileh-envlenvisionlreports15021.rpt <br />