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Date run 9/16/2008 10:18:52AI SAN J' `ZUIN COUNTY ENVIRONMENTAL HE.' —UI DEPARTNIENT Report #5021 <br />Run by Pagel <br />Facility Information as of 9/16/2uu6 <br />Record Selection Criteria: Facility ID FA0003678 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0002746 <br />Owner Name <br />BULK TRANSPORTATION <br />Owner DBA <br />BULK TRANSPORTATION <br />Owner Address <br />3032 S ELDORADO ST <br />Phone <br />STOCKTON, CA 95206 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />909-594-2855 <br />Mailing Address <br />PO BOX 6068 <br />Location Code <br />STOCKTON, CA 95206 <br />Care of <br />001 - GUTIERREZ, STEVE <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0003678 <br />Facility Name <br />BULK TRANSPORTATION <br />Location <br />3032 S EL DORADO ST <br />(,_// <br />STOCKTON, CA 95206 <br />Phone <br />209-466-0481 <br />Mailing Address <br />PO BOX 6068 <br />N <br />STOCKTON, CA 95206 <br />Care of <br />2226 - CaIARP PROGRAM <br />Location Code <br />01-STOCKTON <br />BOIS District <br />001 - GUTIERREZ, STEVE <br />APN <br />17702002 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0003256 New Account ID: <br />Mail Invoices to Facility Mail Invoices to: Owner / <br />Account Name BULK TRANSPORTATION <br />Account Balance as of 9/16/2008: $0.00 <br />Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? '- IA Delete <br />2220 - SM HW GEN <5 TONS/YR <br />PR0513901 <br />EE0008317 - RAYMOND VON FLUE <br />Inactive <br />Y <br />N <br />(,_// <br />I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0511845 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A <br />I D <br />2226 - CaIARP PROGRAM <br />PR0514610 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A <br />I D <br />2244 - PACT TRANSFER RECORD - OES <br />PR0519722 <br />EE0000000 - HAZ MAT SJC OES <br />Active <br />Y <br />N <br />A <br />I D <br />2301 - UST STATE SURCHARGE FEE <br />PR0507688 <br />EE0005642 - MICHELLE HENRY <br />Inactive <br />Y <br />N <br />A <br />I D <br />2361 - UST FACILITY <br />PR0231093 <br />EE0005642 - MICHELLE HENRY <br />Inactive <br />Y <br />N <br />A <br />I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARiPR0507396 <br />EE0005642 - MICHELLE HENRY <br />Inactive <br />Y <br />N <br />A <br />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 <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 Receive y n/ <br />RENS: \. �rl Date U 0 Account out: Date <br />COMMENTS: <br />\\pIns-eInsgI-nt\apps\envisions\reports\5021.rpt <br />