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FRun <br /> y n 52882011 12:31:52PI �A]v��JUIN COUNTY ENVIRONMENTAL HE, DEPARTMENT <br /> Report X5021 <br /> Facility Information as of 1/28/2011 Pagel <br /> d selection Criteria: Facility ID FA0016751 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> SSN!Fed Tax ID <br /> Owner ID OW0013592 New Owner ID <br /> Owner Name GARY WINTERS <br /> Owner DBA GARY WINTERS <br /> Owner Address 9202 WOODWARD <br /> MANTECA, CA 95337 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 9202 WOODWARD <br /> MANTECA, CA 95337 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016751 <br /> Facility Name GARY WINTERS <br /> Location 9202 WOODWARD �. <br /> MANTECA, CA 95337 <br /> Phone 209_823-4412 x0 <br /> Mailing Address 9202 WOODWARD <br /> MANTECA, CA 95337 <br /> Cara of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 22405008 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 AR0029633 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name GARY W INTERS (Circle One) <br /> Account Balance as of 712812011: $0.00 <br /> (Circle One) <br /> Transfer to Activellaaetve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2221 -USED OIL ONLY-<5 TONSIYR PR0531026 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO524936 Active Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0531025 EED00267G-MUNIAPPA NAIDU Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO532393 Active 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 spec,PHSIEHD hourly charges associated with this <br /> facility 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 Ordinate Codes andlor Standards and <br /> State and/or Federal Laws, <br /> APPLICANT'S SIGNATURE: Date ! / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 ! <br /> Water System to be TRANSFERED: Amount Paid Date I ! <br /> Payment Type Check Number Received by <br /> E <br /> Date I 1 Account out: _ Date ! I l <br /> COMMl <br /> COMMENTS: <br /> 11eh-envlenvisionlreports15021.rpt <br />