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Date run 7/12/2011 11:14:42AI SAN JO JIN COUNTY ENVIRONMENTAL HEAI' DEPARTMENT RcpoR#5021. <br /> Run by *awl �,i Pagel Y <br /> Facility Information as of 7/12/2011 <br /> Record Selection Criteria: Facility ID FA0018431 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN 1 Fed Tax ID <br /> Owner ID OW0015145 New owner ID : 1 <br /> Owner Name NATIONAL CONSTRUCTION RENTALS i <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/Business 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,4 Alt Phone <br /> BOS District 003-BESTOLARIDES Fax <br /> APN EMail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name RAMIREZ, SIDNEY <br /> Title <br /> I <br /> Day Phone 916-679-6285 <br /> Night Phone ! <br /> i <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032553 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility 1 Account ' <br /> Account Name NATIONAL CONSTRUCTION RENTALS INC (Circle One) <br /> Account Balance as of 7/12/2011: $0.00 <br /> 1, (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 PR0527223 EE0004045-TED TASIOPOULOS Inactive Y N A I D <br /> 4244-PUMPER TRUCK PRO535845 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> 4255-CHEMICAL TOILETS PR0527616 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,and/or project specific.PHSIEHD hourly 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 Ordinace Codes and/or Standards and <br /> State andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> F <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date I 1 <br /> Payment Type Check Number Recely <br /> << REHS: Date r 1 r Z! (l Account out: Date 1 I t/ f <br /> COMMENTS: �� <br /> "" Ileh-envlenvisionlreports15021.rpt <br />