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Date run 9/9/2013 10:43:44AM SAN JOWIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/9/2013 <br /> Record Selection Criteria: Facility ID FA0021913 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0007167 Case Number: H01679 New Owner ID <br /> Owner Name WRIGHT REVOCABLE TRUST(JOHN S WR <br /> Owner DBA WRIGHT'S PETROLEUM INC <br /> Owner Address 1212 SIERRA DR <br /> ESCALON, CA 95320 <br /> Home Phone 209-838-7935 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1512 WEISS WAY <br /> ESCALON, CA 95320 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021913 <br /> Facility Name WRIGHT'S PETROLEUM INC <br /> Location 1512 WEISS WAY <br /> ESCALON, CA 95320 <br /> Phone 209-838-7935 <br /> Mailing Address 1512 WEISS WAY <br /> ESCALON, CA 95320 <br /> Care of WRIGHT'S REVOCABLE TRUST <br /> Location Code 06- ESCALON Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 22708001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name EVA WRIGHT <br /> Title TRUSTEE <br /> Day Phone 209-838-7935 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0039918 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name GROUND ZERO ANALYSIS INC (Circle One) <br /> Account Balance as of 9/9/2013: $-875.00 <br /> (Circle One) <br /> Transfer to AeWellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0637963 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andhor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form Ialso certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State andlor <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 Check Number Received by <br /> REHS: Date_/ / Account out: Date_/ / <br /> COMMENTS: <br />