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Date run " 2/20/2013 11:01:05Ai SAN JOIN COUNTY ENVIRONMENTAL HEAW DEPARTMENT Report 45021 <br /> Run by Paget <br /> Facility Information as of 2/20/2013 <br /> Record Selection Criteria: Facility ID FA0021620 <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 OW0017779 New Owner ID <br /> Owner Name JOHNSON, OLIVER <br /> Owner DBA <br /> Owner Address 11493 FOLSOM BLVD <br /> RANCHO CORDOVA, CA 95742 <br /> Home Phone 916-635-6666 <br /> Work/Business Phone 209-946-0028 <br /> Mailing Address 2803 S HWY 99 FRONTAGE 114q3 SWk_— ✓ <br /> STOCKTON, CA 95215 <br /> Care of JOHNSON, OLIVER <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0021620 <br /> Facility Name TKO RECYCLING 2 <br /> Location 2803 S HWY 99 FRONTAGE <br /> STOCKTON, CA 95215 <br /> Phone 209-946-0028 <br /> Mailing Address 2803 S HWY 99 FRONTAGE T11LI13 ds6r, - y <br /> STOCKTON, CA 95215 C Z <br /> Care of JOHNSON, OLIVER <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 17911011 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name OLIVER JOHNSON <br /> Title OWNER <br /> Day Phone 209-946-0028 <br /> Night Phone 916-635-6666 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0039173 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name TKO RECYCLING 2 (CirdeOne) <br /> Account Balance as of 2/20/2013: $290.00 <br /> (Circle One) <br /> Transfer to Active/Inadve <br /> am/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 11T1921 - MBP-Regular-Primary Location PR0537552 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,aclmowledge that all site,andor project specific,PHSIEHD 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 Codas anNor Standards and State andor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: °`4 Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / I - <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received <br /> RENS: Date / /_ Account out: Date .2 /��_/ �.3 <br /> COMMENTS: <br />