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Date run 11/8/2017 2:51:03PIV SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 Run by ` Paget Facility Information as of 11/8/2017 Record Selection Criteria: Facility ID FA0010425 Make changes/corrections in RED ink. INFORMATION CHANGE(date) OWNERSHIP CHANGE(date) OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID Owner ID OW0008425 Case Number: H08067 New Owner ID : Owner Name Pacific Southwest Container LLC, a Delaware Owner DBA PACIFIC SOUTHWEST CONTAINER OwnerAddress 4530 E LECKRON RD MODESTO, CA 95357 Home Phone 209-526-0444 Work/Business Phone 209-526-0444 Mailing Address 4530 E LECKRON RD MODESTO, CA 95357 Care of FACILITY FILE INFORMATION Site Mitigation Facility Facility ID/CERS ID FA0010425 10183549 Facility Name PACIFIC SOUTHWEST CONTAINER Location 4343 E FREMONT ST STOCKTON, CA 95215 Phone 209-526-0444 x Mailing Address 4530 E LECKRON RD MODESTO, CA 95357 Care of Pacific Southwest Container LLC Location Code 99- UNINCORPORATED A Alt Phone BOS District 002 - MILLER, KATHERINE Fax APN 14328039 EMail: EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title / Day Phone / Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0017425 \\\ NewAccount ID: Mail Invoices to Account Mail Invoices to: Owner / Facility / Account Account Name PACIFIC SOUTHWEST CONTAI R (Circle One) Account Balance as of 11/8/2017: $0.00 (Circle One) Transferto ActiveAnactve Program/Element and Description Record ID Employee ID and Name Status New Owneo Delete 1921 -HMBP-Regular-Primary Location PR0520340✓ EE0008709-JAMIE LIMA Active Y N AD 2220-SM HW GEN<5 TONS/YR PR0528554 EE0000031 -ELIANNA FLORIDO Active Y N A D 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512713 EE0000000-HAZ MAT SJC DES Inactive Y N A I D 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0232096 EE0000451 -STEVE SASSON Inactive Y N A I D 2399-UNIFIED PROGRAM FAC STATE SURCHARGE Fl PR0510425 EE0000000-HAZ MAT SJC OES Inactive Y N A I D 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PR0529235 EE0000031 -ELIANNA FLORIDO Active Y N A©D ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO533738 Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anclor project specOrio,PHSEHD hourly charges associated with this facility or activity will be billed to the pally identied 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 antler Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: '$25.00= Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received b �J EHD Staff: Date / /�_ Account out: Date /11 / I COMMENTS: i.� /,- LC' n _ IO� �IfIV01Ce J/: &4*