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Date run , 3/8/2010 8:28:41AM SAN JC IN COUNTY ENVIRONMENTAL HEA` DEPARTMENT Report#5021 <br /> Run'by- 1273 Pagel <br /> Facility Information as of 3/8/201 <br /> Record Selection Criteria: Facility ID FA0016805 <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 OW0013646 New Owner ID <br /> Owner Name LDC EQUIPMENT LLC <br /> Owner DBA LDC EQUIPMENT LLC <br /> Owner Address 13466 LINN RD <br /> LODI, CA 95240 <br /> Home Phone 209-727-5457 <br /> Work/Business Phone 209-327-2489 <br /> Mailing Address 13466 LINN RD <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016805 <br /> Facility Name LDC EQUIPMENT LLC <br /> Location 21001 E HWY 4 <br /> STOCKTON, CA 95215 <br /> Phone 209-727-5457 <br /> Mailing Address 13466 LINN RD a OD <br /> LODI, CA 95240 a <br /> Care of <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN EMail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ROBERT PERRY <br /> Title <br /> Day Phone 209-327-2489 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029687 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name LDC EQUIPMENT LLC (Circle One) <br /> Account Balance as of 3/8/2010: $262.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSlYR PR0529699 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2223-AGRICULTURAL HAZ MAT STORAGE FACILPRO524990 Inactive Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO529698 EE0009488-JEFFREY WONG Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO532222 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that ail site,and/or project specific,PHS/EHD 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: "$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Receiv <br /> REHS: Date ! / Account out: Date <br /> COMMENTS: <br /> 1 r <br /> \\eh-env\envision\reports\5021.rpt <br />