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Date run 1/24/2008 10:45:17AK SAN JCIWIN COUNTY ENVIRONMENTAL HEA11SH DEPARTMENT Repnd#5021 <br /> Run by Paget <br /> Facility Information as of 21F <br /> Record selection Criteria: Facility ID FA0000629 <br /> FILEMake changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0000504 New Owner ID <br /> Owner Name USA WASTE SERVICES, INC <br /> Owner DBA MODESTO DISPOSAL SERVICE <br /> Owner Address 8761 YOUNGER CREEK DR <br /> SACRAMENTO, CA 95828 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-538-2210 <br /> Mailing Address 730 INDUSTRY WAY <br /> ATWATER, CA 953019573 <br /> Care of USA WASTE SERVICES, INC <br /> FACILITY FILE INFORMATION <br /> Facility IOATWATER <br /> O h ✓� <br /> Facility NamENTALS INC <br /> LocatioY WAY <br /> A 953019573 <br /> Phon <br /> Mailing Address 730 INDUSTRY WAY <br /> ATWATER, CA 953019573 <br /> Care of THOM CLARK <br /> Location Code 98_OUT OF COUNTY APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000628 NewAcaount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CAL STATE RENTALS INC (Circle One) <br /> Account Balance as of 1/24/2008: 68=66- <br /> (Circle One) <br /> Transfer to ActivegmeWe <br /> Program/Element and Description Record ID Employee In and Name Status New Omen Delete <br /> 4244-PUMPER TRUCK PRO420138 EE0004045-TED TASIOPOULOS Inactive Y N A I D <br /> 4244-PUMPER TRUCK PRO420139 EE0009374-LARRY GODINHO Inactive Y N A I D <br /> 4244-PUMPER TRUCK PRO506470 EE0009374-LARRY GODINHO Inactive Y N A I D <br /> 4244-PUMPER TRUCK �PRO526631 EE0004045-TED TASIOPOULOS -Ac" Y N A a D <br /> 4255-CHEMICAL TOILETS "PR0420137 EE0004045-TED TASIOPOULOS AGOVL— Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PPIS/EPID hourly charges associated Win this <br /> facility or activity vAll be billed to the party,Identified as the OWNER on this form. I also certify,that all operations will be performed in accordance vdth all applicable Ordinace Cotler and/or standards and <br /> Stale and/or Federal La . <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 Received by <br /> REH5. �'fO LjI A Date Acc}ount out.: Date <br /> COMMENTS: �/��� � � 1✓t"�/T\�CO' D�C��J�"T -.7 <br /> \\phs-ehsgl-nt\apps\aMsions\reports\5021.rpt <br />