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Date run 1/20/2010 2:21:33PN SAN JOA'`IN COUNTY ENVIRONMENTAL HEALT--DEPARTMENT Report#5021 <br /> Run by _� Paget <br /> Facility Information as of 1/20/201b"" <br /> Record Selection Criteria: Facility ID FA0018335 <br /> Make changestcorrections in RED Ink. 6 <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0015056 New Owner ID <br /> Owner Name KEMP, RONALD <br /> Owner DBA <br /> Owner Address 4447 S AIRPORT WAY STE B <br /> STOCKTON, CA 95206 <br /> Home Phone 209-234-7994 <br /> Work/Business Phone Not Specified <br /> Mailing Address 4447 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Care of KEMP, RONALD <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018335 <br /> Facility Name ONSITE ELECTRONIC RECYCLING <br /> Location 4447 S AIRPORT WAY STE B <br /> STOCKTON, CA 95206 <br /> Phone 209-234-7994 <br /> Mailing Address PO BOX 655 <br /> CLEMENTS, CA 95227 <br /> Care of KEMP, RONALD <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 17728033 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name RONALD KEMP <br /> Title <br /> Day Phone 209-234-7994 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032314 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name ONSITE ELECTRONIC RECYCLING (c:ueOne) <br /> Account Balance as of 1/20/2010: $0.00 <br /> (Circle One) <br /> Transfer to Activellnacwe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2217-APPLIANCE RECYCLER PR0530082 EE0008317-RAYMOND VON FLUE Active Y N A j D <br /> 2218-CRT HANDLER PRO527051 EE0008317-RAYMOND VON FLUE Active Y N A D <br /> 2220-SM HW GEN<5 TONS/YR PRO530081 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge Mat all site,and/or project specific.PHSIEHD hourly charges associated wdh this <br /> Way w acMi coil be billed to the pang identified as the OWNER on this form. I also cerMfy mat all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State andfor Federal Laws. <br /> ,3(3S I, , K'W� <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: •$372.00= Amount Paid Date <br /> Payment T e Check Number Receiv y <br /> REHS: ,y Iit, A�i�t Aa Date /?�/�� Account out: Date /it <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />