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Date run 3/18/2013 2:21:49PR SAN, QUIN COUNTY ENVIRONMENTAL HI .'H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/18/2013 <br /> Record Selection Criteria: Fi Aity 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 PO BOX 8810 <br /> STOCKTON, CA 95208 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0006188 10,182,045 <br /> Facility Name UNITED RENTALS <br /> Location 210 E KETTLEMAN LN <br /> LODI, CA 95240 <br /> Phone 209-334-2850 <br /> Mailing Address PO BOX 8810 <br /> STOCKTON, CA 95208 <br /> Care of - - — -- ----� <br /> Location Code <br /> BOS District 004 -VOGEL, KEN <br /> APN 06206002 <br /> �risl . <br /> EMERGENCY NOTIFICATION CONTACT INFORMA _ 1 <br /> Contact Name 1 � (}�"� �i � //) �-h <br /> Title <br /> Day Phone <br /> Night Phone /�..!—�^1 np <br /> ACCOUNTS RECEIVABLE FILE INFORMATION /� `rJ <br /> Account ID AR0007283 C� I 1 O rE5 unae_ So I`oiln/� <br /> se_� <br /> Mail Invoices to Facility <br /> Account Name UNITED RENTALS b� <br /> Account Balance as of 3/18/2013: $683.00 <br /> Program/Element and Description Record <br /> 1921 -HMBP-Regular-Primary Location PR052ut5z CGVVVOTVV-J^tv,iLL Lr,C­1 /°�� <br /> 2220-SM HW GEN<5 TONS/YR PR0522179 EE0001422-ARIS CACAPIT Active Y N A (D D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOfPR0513496 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 /> 2399-UNIFIED PROGRAM FAC STATE SURCHARCPR0511208 EE0000000-HAZ MAT SJC OES Inactive Y N A �I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATI%oPR0522200 EE0001422-ARIS CACAPIT Active,Exempt Y N A D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO524693 EE0002620-ALFONSO ARAMBULA Inactive Y N A 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,PHSIEHD hourly charges associated with this f cility <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 a d'or <br /> IJ <br /> Federal s. P - l <br /> 3126 V t 13 4Ez 2� 3 w <br /> APPLICANT'S SIGNATURE: r t " Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Da <br /> Payment Type Check Number Receive <br /> S (Xyy\U� Date / /I Account out: Date <br />