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Date run 1/24/2008 10:42:59AA SAN JOIN COUNTY ENVIRONMENTAL HE DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1/24/2 <br /> Record Selection Criteria: Facility ID FA0001492 <br /> Make changes/corrections in RED ink or pencil. <br /> r� a INFORMATION CHANGE(date) <br /> IIS. ,�: OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0001163 New Owner ID <br /> Owner Name WASTE MANAGEMENT OF CALIF INC <br /> Owner DBA <br /> Owner Address 2769 W HATCH RD <br /> MODESTO, CA 95358 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-538-2210 <br /> Mailing Address 2769 W HATCH RD <br /> MODESTO, CA 95358 <br /> Care of WASTE MANAGEMENT OF CALIF INC <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001492 <br /> Facility Name CAL STATE RENTALS &SALES <br /> Location 2150 E FREMONT ST <br /> STOCKTON, A 95205 <br /> Phone 0 <br /> Mailing Address 730 INDUSTRY WAY <br /> ATWATER, CA 95301 <br /> Care of WASTE MANAGEMENT OF CALIF INC <br /> Location Code 01 -STOCKTON APN:15313008 <br /> BOS District 001 - GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0001491 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CAL STATE RENTALS &SALES (Circle One) <br /> Account Balance as of 1/24/2008: $2164@=90- <br /> (Cirde One) <br /> Transfer to Adiwvinadve <br /> Program/Elemem and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK PR0420123 EE0005944-MICHAEL ESCOTTO Inactive Y N A I D <br /> 4244-PUMPER TRUCK 'APR0420146 EE0007379-AMANDA BOERTIEN -Aefwe+ Y N A D <br /> 4244-PUMPER TRUCK Y-PR0420147 EE0007379-AMANDA BOERTIEN -AetiVe- Y N A I D <br /> 4244-PUMPER TRUCK PRO504927 EE0005944-MICHAEL ESCOTTO Inactive Y N A I D <br /> 4244-PUMPER TRUCK PR0506748 EE0005944-MICHAEL ESCOTTO Inactive Y N A I D <br /> 4244-PUMPER TRUCK K PRO518834 EE0007379-AMANDA BOERTIEN .4G#" Y N A D <br /> 4244-PUMPER TRUCK X PR0518835 EE0007379-AMANDA BOERTIEN -AGPw Y N A D <br /> 4244-PUMPER TRUCK +,PR0518836 EE0007379-AMANDA BOERTIEN AeSive Y N A D <br /> 4246-PUMPER YARD '-12130420050 EE0007379-AMANDA BOERTIEN Aaivs-_ Y N A D <br /> 4255-CHEMICAL TOILETS A-PR0420095 EE0007379-AMANDA BOERTIEN Aciivo-- Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,opemlor or agent of same,acknowledge that all site,andlor project specific.PHS/EHD hourly charges associated with this <br /> facility or acgvity will be billed to the party dentified as the OWNER on this form. I also certify that all operations will be performed in accordwce with all applicable Ordinace Codes and/or Standards and <br /> Stale and/c,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 Dale <br /> Payment Type Check Number Received by <br /> REHS: Date / Account out: I / Date <br /> COMMENTS <br /> �zy/r78 <br /> \\phs�hsgl-nl\apps\envisions\reports\5021.rpt <br />