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Date run /23/2008 9:06:15A SAN JOAr"TIN COUNTY ENVIRONMENTAL HEAL'r"DEPARTMENT Report- 1273 <br /> -L Facility Information as of 12123I206tr-" Pagel <br /> Record selection Criteria: Facility ID FA0000253 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN 1 Fed Tax ID <br /> Owner ID OW0000206 New Owner ID <br /> Owner Name WILLIAMS, DARREN T <br /> Owner DBA WILLIAMS SANITARY SERVICE <br /> OwnerAddress 61 HANSON LN <br /> BRENTWOOD, CA 94513 <br /> Home Phone 925-634-4855 <br /> Work/Business Phone Not Specified <br /> Mailing Address 61 HANSON LN <br /> BRENTWOOD, CA 94513 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000253 <br /> Facility Name WILLIAMS SANITARY SERVICE <br /> Location 61 HANSEN LN <br /> BRENTWOOD, CA 94513 <br /> Phone 925-634-4855 <br /> Mailing Address PO BOX 20 <br /> BRENTWOOD, CA 94513 <br /> Care of DARREN WILLIAMS <br /> Location Code 98 -OUT OF COUNTY Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DARREN WILLIAMS <br /> Title <br /> Day Phone 925-634-4855 <br /> Night Phone 925-584-4548 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000252 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility 1 Account <br /> Account Name WILLIAMS SANITARY SERVICE fCirdeOne) <br /> Account Balance as of 12/23/2008: $356.00 <br /> (Circle One) <br /> Transfer to Activellnacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner) Delete <br /> 4244-PUMPER TRUCK PR0420121 EE0004045-TED TASIOPOULOS Active Y N A ffl D <br /> 4244-PUMPER TRUCK PRO527254 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> 4255-CHEMICAL TOILETS c.`n(Lytoptu�.�PR0527255 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourry 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 Ordinate Codes and/or Standards and <br /> State andfor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / 1 <br /> Program Records to be TRANSFERED: "$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date I I <br /> Payment Type Check Number Received by <br /> REHS: -�� Date-/-/ Account out: Date 2L 1 1� <br /> COMMENT : <br /> llphs-ehsgl-ntlappslenvisionslreports15021.rpt <br />