Laserfiche WebLink
Date run 518/2013 4:53:20PM SAN JO UIN COUNTY ENVIRONMENTAL HEAT I DEPARTMENT Report#5021 <br /> Run by <br /> Pagel <br /> Facility Information as of 5/812013 <br /> Record election Criteria Facility 10 FA0010259 <br /> Make changes/corrections in RED ink, <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008259 Case Number: H07508 New Owner ID <br /> Owner Name M&M BUILDERS SUPPLY <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business.Phone 209-835-0717 <br /> Mailing Address PO BOX 1107 <br /> TRACY, CA 95378 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID!CERS ID FA0010259 10,183,375 <br /> Facility Name M&M BUILDERS SUPPLY <br /> Location 8010 W ELEVENTH ST <br /> TRACY, CA 95376 <br /> Phone 209-833-1093 <br /> Mailing Address PO BOX 1107 <br /> TRACY, CA 95378 <br /> Care of SAME <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 25016003 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017259 New Account ID: <br /> Mail invoices to Account Mail Invoices to: Owner / Facility 1 Account <br /> Account Name M&M BUILDERS SUPPLY (SOUTH YARD) (Circle One) <br /> Account Balance as of 51812013: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1925-HMBP-Multisite Secondary Location PR0512547 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0510259 EE0000000-HAZ MAT SJC OES Inactive Y N A D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO535328 EE0002620-ALFONSO ARAMBULA Inactive 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,PHS/El hourly charges associated with this facility <br /> 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 Ordinance Codes ancvor Standards and Slate andbr <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date l I <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date ! <br /> Payment Type , Check Number Receiv <br /> REHS: ,�, fr Date 1 1 1�_ Account out: Date 1 !� <br /> COMMENTS: <br /> R�J�- -r�, IIL4 <br />