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Date run 2/26/2013 4:08:39PN SAN JO AN COUNTY ENVIRONMENTAL HEA1 DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/26/2013 <br /> Record Selection Criteria: Facility ID FA0006188 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0004931 New Owner ID <br /> Owner Name UNITED RENTALS <br /> Owner DBA UNITED RENTALS <br /> Owner Address 1581 CUMMINGS STE DR 155 <br /> MODESTO, CA 95351 <br /> Home Phone Not Specified <br /> Work/Business Phone 203-622-3131 <br /> Mailing Address 210 E KETTLEMAN LN TO D`f g 11) <br /> LODI, CA 95240 S�y a_td� C'A 65� <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006188 <br /> Facility Name UNITED RENTALS <br /> Location 210 E KETTLEMAN LN <br /> LODI, CA 95240 <br /> Phone 209-334-2850 <br /> Mailing Address 210 E KETTLEMAN LN D 1 0 <br /> LODI, CA 95240 115 2 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 06206002 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0007283 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name UNITED RENTALS (Circle One) <br /> Account Balance as of 2/26/2013: $683.00 <br /> (Circle One) <br /> Transfer to Active(Inactve <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0520752 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO522179 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOtPR0513496 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0504402 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2a29-UNIFIED PROGRAM FAC STATE SURCHAR(PR0511208 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> �!PWASTE <br /> AST FAC >/=1,320-<10 K GAL CUMULATI\oPR0522200 EE0001422-ARIS CACAPIT Active,Exempt Y N A I D TIRE SITE-EXEMPT PR0524693 EE0002620-ALFONSO ARAMBULA Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PR0533829 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 and/or <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 by <br /> REHS: Date / / Account out: �,1�i Date 2/ l��li, l� <br /> COMMENTS: FU� -? ��-1 <br />