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Date ran 1/30/2004 2:56:34PB SAN JjW COUNTY ENVIRONMENTAL HE J DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as 1 1/30/2 4 <br /> Record Selection Criteria: Fifty ID FA0009860 <br /> Make changes/corrections in RED ink or penc'. <br /> J � INFORMATION CHANGE(date) SD � <br /> OWNER FILE INFORMATION <br /> `-�,.f`s+■��"f�r OWNERSHIP CHANGE(date) <br /> Owner ID OW0007860 New Owner ID <br /> Owner Name MCLAUGHLIN, DANNY <br /> Owner DBA MCLAUGHLIN REFUSE EQUIPMENT IN <br /> Owner Address PO BOX 106 <br /> LOCKEFORD, CA 95237 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-333-4414 <br /> Mailing Address PO BOX 106 <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009860 <br /> Facility Name MCLAUGHLIN REFUSE EQUIP, INC <br /> Location 11900 E LOCKE RD <br /> LOCKEFORD, CA 95237 <br /> Phone 209-333-4414 <br /> Mailing Address PO BOX 106 <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN:051-160-04 <br /> BOS District 004 -SEIGLOCK, JACK SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016860 NewAccount ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name MCLAUGHLIN, DANNY (Circle One) <br /> Account Balance as of 1/30/2004: $0.00 <br /> (Circle One) <br /> Transfer to Activelinactve <br /> New Owner Delete <br /> Program/Element and Description ord ID Emplo D Name status <br /> 2220-SM HW GEN<5 TONS/YR P2514065 Inactive Y N UA D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512148 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PR0505913 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0521034 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509860 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0515511 EE0005838-ADRIENNE ELLSAESSEActive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project speck,PHS/EHD hourly charges associated with this <br /> facility W activity will be billed to the party identified as the OWNER cm this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> Stale andlor Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: —*$155.00=— Amount Paid Date / ! <br /> Payment Tye ,,.� Check Number Received by <br /> RENS: .1,NLA-- Date Account out: Date ;1- /3/0 <br /> COMMENTS: � r/� ^/^ _�� . <br /> �C'�i ut E 2 q r'b Ghat / �/6VV/ b <br /> \\Phs-ehsq I-nt\apps\Envi s ions\Reports\5021.rpt <br />