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Date run 8/9/2010 9:53:35AM SANUIN COUNTY ENVIRONMENTAL HE4fH DEPARTMENT Report#5021 <br /> Run by op Pagel <br /> Facility Information as of 8/9/2010 <br /> Record Selection Criteria: FacilityID FA0009284 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax to <br /> OwnerlD OW0007284 Case Number: H02826 NewOwnerlD : <br /> Owner Name ABELL CORP <br /> Owner DBA ABELL CORP <br /> Owner Address 8055 S ASH ST <br /> FRENCH CAMP, CA 95231 <br /> Home Phone Not Specified <br /> work/Business Phone 318-343-7565 <br /> Mailing Address PO BOX 4150 <br /> MONROE, LA 712114150 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009284 <br /> Facility Name POLY PROCESSING COMPANY LLC <br /> Location 8055 S ASH ST <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-982-4904 x0 <br /> Mailing Address 8055 S ASH ST <br /> FRENCH CAMP, CA 95231 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 193-090-09 EMail : MC o/ aG /.✓ .Ce.a <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name -rC'Wy/(6y-x <br /> Title Pl/aft77 DayPhone (/169)j�1'f�Jbj6 <br /> Night Phone ( y09) gSy - S1b7 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> New Account lD: <br /> AccountlD AR0016284 : <br /> Mail Invoices to Owner Mail Invoices to: Owner I Facility / Account <br /> (Circle One) <br /> Account Name ABELL CORP <br /> Account Balance as of 8/9/2010: $0.00 (Circle one) <br /> Transfer to Active/Inaclve <br /> Program/Element and Description <br /> Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0513746 EE0002646-THUY TRAN Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511572 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO519517 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO509284 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0532961 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,PHS/EHO hourly charges associated with this <br /> facility 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 Ordinace Codes and/or Standards and <br /> Stale andfor Federal Laws. <br /> APPLICANT'S 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 TycheckNumber ; Receiv {� <br /> Date qL�2/ U Account out Date <br /> REHS: <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />