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Date""' 1/30/2010 9:27:23A! SAN JUIN COUNTY ENVIRONMENTAL HEE�3 DEPARTMENT <br /> Runby Report A'5027 <br /> Facility Information as of 11/30/2010 Pagel <br /> Record Selection Criteria: Facility ID FA0018431 <br /> F1Make changeslcorrections in RED ink. <br /> AlINFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID <br /> Owner ID OW 0015145 New Owner ID <br /> Owner Name NATIONAL CONSTRUCTION RENTALS <br /> Owner DBA NATIONAL CONSTRUCTION RENTALS <br /> Owner Address 6833 32ND ST <br /> NORTH HIGHLANDS, CA 95660 <br /> Home Phone 916-679-6285 <br /> Work/Susiness Phone Not Specified <br /> Mailing Address 6833 32ND ST <br /> NORTH HIGHLANDS, CA 95660 <br /> Care of RAMIREZ, SIDNEY <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018431 <br /> Facility Name NATIONAL CONSTRUCTION RENTALS INC <br /> location 12833 S MANTHEY RD <br /> LATHROP, CA 95330 <br /> Phone 916-679-6285 <br /> Mailing Address 1300 BUSINESS CENTER DR <br /> SAN LEANDRO, CA 945772242 <br /> Care of RAMIREZ, SIDNEY <br /> Location Code 99- UNINCORPORATED>< Alt Phone <br /> BOS District 003- BESTOLARIDES Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name RAMIREZ, SIDNEY <br /> Title <br /> Day Phone 916-679-6285 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032553 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility / Account <br /> Account Name NATIONAL CONSTRUCTION RENTALS INC (CirdeOne) <br /> Account Balance as of 1113012010: $218.00 <br /> (Cirde One) <br /> Transfer to ActiveAnactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4244-PUMPER TRUCK ',C Mp %,PF20527223 EE0004045-TED TASIOPOU LOS Active Y N A D <br /> 4255-CHEMICAL TOILETS PRO527616 EE0004045-TED TASIOPOU LOS Active Y N A l 0 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this <br /> facility or acdvitywlll 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 andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I 1 <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date ! <br /> Water System t TRANSFERED. Amount Paid Date I <br /> Payment T Check Received by <br /> REHS: Date /Z ! 6 1 r'0 Account out: Date �. 10; <br /> COMME <br /> J �y (,/,w O/cI{ R c7- iA <br /> , FA 0'52-77—y3 <br /> A. -Y,.Gf�.n�w`11rt.ttifG . ��rnl� s+,..�-) �}��.e� f Q\)t1_\j 5 3 S S`4 S � <br /> kleh-envlenvisionlreports15021.rpt <br />