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Report#5021 <br /> Elnaterun SAN JUIN COUNTY ENVIRONMENTAL HEA�I DEPARTMENT aget <br /> Facility Information as of 1/29/2013 <br /> Facility ID FA00I— <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> OWNER FILE INFORMATION New Owner ID <br /> Owner ID OW0016355 <br /> Owner Name G&G REBAR INC <br /> Owner DBA G&G REBAR INC <br /> Owner Address 474 AURORA ST <br /> STOCKTON, CA 95203 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-472-0777 <br /> Mailing Address 474 S AURORA ST <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 f u 7 <br /> Mailing Address 474 AURORA ST2lrtrt� R is CA Q5j/li _G 62o <br /> STOCKTON, CA 95746 <br /> Care of Alt Phone <br /> Location Code 01 -STOCKTON Fax <br /> BOS District 001 -VILLAPUDUA Email: <br /> APN 15126043 <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 /> AccountlD AR0035511 Mail Invoices to: Owner I Facility / Account <br /> Mail Invoices t0 Owner (Circle One) <br /> Account Name G&G REBAR INC <br /> Account Balance as of 1/2912013: $0.00 Circle One) <br /> Transfer to Acbve'Ina°Iva <br /> Record ID Employee ID and Name <br /> Status New Owner? Delete <br /> aMElemenl and Description Active Y N A I D <br /> 1927 MBP-Regular-Primary Location PR0530778 EE0009817-ROBERT LOPEZ Inactive Y N A I D <br /> C-ELECTRONIC REPORTING STATE SURCH,PR0532048 acknowledge that all site,endor protect specific,PHS/EHD hourly charges associated with this facility <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same, <br /> or activity will be billed to the party identified as the OWNER on this forth I also certify that all operations will be performed in accordance with all applicable Ordinance codes endor Standards and State en or <br /> Federal Laws. <br /> Date <br /> APPLICANT'S SIGNATURE: <br /> Amount Paid Date <br /> Program Records to be TRANSFERED: '$25'00 Amount Paid Date_/—/— <br /> Water System to be TRANSFERED: Recelv <br /> Payment T( A Check Number _ Date <br /> REHS: <br /> Ili n Date�_/ / Account out: <br /> COMMENTS: �� 1 v� n <br />