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Date run 2/6/2004 10:57:26AM SAN .-/ )UIN COUNTY ENVIRONMENTAL HE/ 'I DEPARTMENT Report #5021 <br />Run by Pagel <br />Facility Information as of 2/6/20u4 <br />Record Selection Criteria: Facility ID FA0003678 <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <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 PO BOX 6068 <br />STOCKTON, CA 95206 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0003678 <br />Facility Name <br />BULK TRANSPORTATION <br />Location <br />3032 S EL DORADO ST <br />A <br />STOCKTON, CA 95206 <br />Phone <br />209-466-0481 <br />Mailing Address PO BOX 6068 <br />STOCKTON, CA 95206 <br />Care of <br />Location Code 01 -STOCKTON <br />BOS District 001 - GUTIERREZ, STEVE <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0003256 <br />Mail Invoices to Facility <br />Account Name BULK TRANSPORTATION <br />Account Balance as of 2/6/2004: $524.00 <br />Program/Element and Description Record ID <br />2220 - SM HW GEN <5 TONS/YR PR0513901 <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511845 <br />2226 - CalARP PROGRAM PR0514610 <br />2244 - PACT TRANSFER RECORD - OES PR0519722 <br />2301 - UST STATE SURCHARGE PR0507688 <br />2361 - NEW MULTI UST FACILITY PR0231093 <br />2399 - UNIFIED PROGRAM FAC STATE SERVICE FPR0507396 <br />New Owner ID : <br />APN:17702002 <br />SIC Code:9900 <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />Employee ID and Name <br />EE0008844 - DINA ABATE <br />EE0000000 - HAZ MAT SJC OES <br />EE0000000 - HAZ MAT SJC OES <br />EE0000000 - HAZ MAT SJC OES <br />EE0007380 - STEVEN SHIH <br />EE0007380 - STEVEN SHIH <br />EE0007380 - STEVEN SHIH <br />(Circle One) <br />Transfer to Active/Inactve <br />Status <br />New Owner? <br />Delete <br />Active <br />Y N <br />A <br />I D <br />Active <br />Y N <br />A <br />I D <br />Active <br />Y N <br />A <br />I D <br />Active <br />Y N <br />A <br />I D <br />Inactive <br />Y N <br />A <br />I D <br />Inactive <br />Y N <br />A <br />I D <br />Inactive <br />Y 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: <br />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 Type Check Number R c i by <br />REHS: Date 2 /�Q_/ Account out: Date / /� <br />COMMENTS: <br />ro Lori P,r- ff,4q ral /� ll� zaNG� �}u�- I,t/lL a • <br />InAC� I/aU� 222iW . V <br />\\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />