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oats ns. 10/1/2008 8:31:OOAh SAN JO' WIN COUNTY ENVIRONMENTAL HEAI "z1 DEPARTMENT Report #5021 <br />j Ronny 1273 fie, Pagel <br />Facility Information as of 10/1/20bC' <br />Record Selection Criteria: Facility In FA0014414 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0011456 <br />Owner Name <br />BILL ELMORE <br />Owner DBA <br />ABEL BUILDING MATERIALS INC <br />Owner Address <br />635 AURORA ST <br />Phone <br />STOCKTON, CA 95203 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-466-3683 <br />Mailing Address <br />PO BOX 757 <br />Location Code <br />STOCKTON, CA 952010757 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0014414 <br />Facility Name <br />ABEL BUILDING MATERIALS INC <br />Location <br />635 AURORA ST <br />STOCKTON, CA 95203 <br />Phone <br />209466-3683 x0 <br />Mailing Address <br />PO BOX 757 <br />STOCKTON, CA 952010757 <br />Care of <br />Location Code <br />BOS District <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) _ <br />SSN / Fed Tax ID <br />Alt Phone <br />Fax <br />EMail : <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0024494 New Account ID: <br />Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br />Account Name BILLELMOREr, ��Bp��/da (Circle One) <br />Account Balance as of 10/1/2008: $117.50, VVL -7 <br />(Circle One) <br />Transfer to Active/Inactve <br />ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br />2244 - PACT TRANSFER RECORD - IDES PRO519272 EE0000000 - HAZ MAT SJC DES Active Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD hourly charges associated With this <br />facility or activity will be bilkW to Bae party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br />Stale and/or Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS: <br />' $20.00 = <br />$372.00 = <br />Date <br />aaao ARD 5a?ze 13 <br />1lphschsgl-nt\apps\envisions\reports\5021. rpt <br />Date <br />Amount Paid Date <br />Amount Paid Date / / <br />Recei <br />Account out: Date /J�/ cy <br />