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Data ran t 2/20/2013 11:23:01 Al SAN JOReport#5021 <br /> IN COUNTY ENVIRONMENTAL HEAOq DEPARTMENT Pagel <br /> Run Facility Information as of 2/20/20'1 <br /> Record Selection Criteria: Facility lD FA0019932 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSNI Fed Tax ID <br /> Owner ID OW0016355 New Owner ID <br /> Owner Name G&G REBAR INC <br /> Owner DBA G&G REBAR INC N <br /> Owner Address 474 AURORA ST _ <br /> STOCKTON, CA 95203 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-472-0777 k <br /> Mailing Address 474 S AURORA ST -L3 r g <br /> STOCKTON, CA 95203 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019932 <br /> Facility Name G&G REBAR INC <br /> Location 474 S AURORA ST <br /> STOCKTON, CA 95203 <br /> Phone 209-472-0777 x0 <br /> 1.,11) <br /> Mailing Address 8771 AUBURN FOLSOM RD UNIT 2480 <br /> GRANITE BAY, CA 95746-0320 EkEIM00471 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 15126043 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION New Account ID: <br /> Account ID AR0035511 <br /> Mail Invoices to: Owner / Facility / Account <br /> Mail Invoices to Owner (Circle One) <br /> Account Name G&G REBAR INC <br /> Account Balance as of 2/20/2013: $305.00 (Circle One) <br /> Transfer to Active/lnactve <br /> on��El,,rarq antl Description Recortl ID Employee ID antl NameStatus New Owne(7 Delete <br /> Y NAI HMBP-Regular-Primary Location PRO530776 EE0009817-ROBERT LOPEZ Active Y N A D <br /> ELECTRONIC REPORTING STATE SURCHrPR0532048 <br /> Inactive <br /> operator or agent of same,acknowledge that all site,ander project specific,PHSIEHD hourly charges associated with this facility <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,op 9 <br /> or activity will be billed to the party identified as the OvvJER on this form 1 also certify that all operations will be performed in accordance with all applicable Ordinance Codes ander Standards and State order <br /> Federal Lewis <br /> Date <br /> APPLICANT'S SIGNATURE: <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid <br /> Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type <br /> Check Number Recall <br /> Date <br /> REHS: Date_/ /_ Account out: G <br /> dliklAu <br /> COMMENTS: Vy vli,il L� <br /> Rill 21�-I `lii <br />