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Date run 3/17/2014 4:18:08PR SAN JO. JIN COUNTY ENVIRONMENTAL HEA; DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/17/2014 <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 R &J DONDERO INC <br /> Owner DBA <br /> Owner Address 20486 E COPPEROPOLIS RD <br /> LINDEN, CA 95236 <br /> Home Phone 209-931-1751 <br /> Work/Business Phone Not Specified <br /> Mailing Address 20486 E COPPEROPOLIS <br /> LINDEN, CA 95236 <br /> Care of RUESEGGER, CINDY <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0016805 10185437 <br /> Facility Name R &J DONDERO INC <br /> Location 21001 E HWY 4 <br /> STOCKTON, CA 95215 <br /> Phone 209-931-1751 <br /> Mailing Address 20486 E COPPEROPOLIS <br /> LINDEN, CA 95236 <br /> Care of RUESEGGER, CINDY <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> Bos District 004 -VOGEL, KEN Fax 4211 <br /> APN 18333015 EMail: o A 4kr0 CA C /ITA , CdA <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029687 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name R &J DONDERO INC (Circle One) <br /> Account Balance as of 3/17/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PRO524990 Inactive Y N A I D <br /> 2221 -USED OIL ONLY-<5 TONS/YR PR0529699 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0529698 EE0009488-JEFFREY WONG Active,I Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532222 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 Receli/ed/15� <br /> REHS: Date _-.3 1 / Account out: I� 4� Date <br /> COMMENTS: <br />