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Date con 5/22/2013 9:18:35AN SAN J*TJIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/22/2013 <br /> Record Selection Criteria: Facility ID FA0009860 <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 OW0007860 New Owner ID : <br /> Owner Name fnUt ftry��C <br /> Owner DBA l IVtPn U,( in U.C. <br /> Owner Address 2624 MINE AND MILL LN �- <br /> LAKELAND, FL 33801 <br /> Home Phone 704-366-7140 <br /> Work/Business Phone 209-333-4414 <br /> Mailing Address 2624 MINE AND MILL LN <br /> LAKELAND, FL 33801 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0009860 10,182,963 <br /> Facility Name <br /> Location 11900 E LOCKE RD <br /> LOCKEFORD, CA 95237 <br /> Phone 209-333-4414 <br /> Mailing Address 2624 MINE AND MILL LN <br /> LAKELAND, FL 33801 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 05116027 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016860 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name WASTEQUIP MFG CO INC (Circle One) <br /> Account Balance as of 5/22/2013: $-20.00 <br /> (Circle One) <br /> Transfer to Activelinadve <br /> ProgramfElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO521034 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514065 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512148 EEOOO0000-HAZ MAT SJC OES InaCtlVE Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PRO505913 EE0000008-LETITIA BRIGGS InaCtIVE Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509860 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO528428 EE0001419-KRISTIAN LUCAS Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO534643 Inactive Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0515511 EE0005838-ADRIENNE ELLSAESSER Active 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 specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this forth I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State andor <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 heck Number Receiv <br /> c )G1Y�12 1�P� Date_/_zz_d3_ Account out: Dated/ / <br />