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Date run 5/5/2011 8:45:50AM SAN JO A OUIN COUNTY ENVIRONMENTAL HEAT TH DEPARTMENT Report#5021 <br /> Pagel <br /> Run by 5290 <br /> *a,r Facility Information as of 5/5/20,-� <br /> Record Selection Criteria: Facility ID FA0009443 <br /> TSSN <br /> anges/corrections In RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION d Tax ID <br /> Owner ID OW0007443 Cner ID <br /> Owner Name LEAR/HAYASHITOwner DBA AMTEX INC <br /> Owner Address 550 CARNEGIE SMANTECA, CA 9 <br /> Home Phone Not Specified <br /> Work/Business Phone 248-447-1500 <br /> Mailing Address 1500 KINGSVIEW DR <br /> LEBANON, OH 45036 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009443 <br /> Facility Name AMTEX INC <br /> Location 550 CARNEGIE ST 7A !� <br /> MANTECA, CA 95337 <br /> Phone 209-239-9095 <br /> Mailing Address 1500 KINGSVIEW DR <br /> LEBANON, OH 45036 <br /> Care of <br /> Location Code 04- MANTECA Alt Phone <br /> BOS District 005-ORNELLAS, LEROY Fax <br /> APN 22119052 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 AR0016443 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name AMTEX INC (Cede One) <br /> Account Balance as of 5/5/2011: $854.50 <br /> (arde Ona) <br /> Transfer to ACINeAnectve <br /> Progranu Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0513839 EE0002670-MUNIAPPA NAIDU Active Y N AI D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511731 EE0000000-HAZ MAT SJC OES Inactive Y N A D <br /> 2226-CaIARP PROGRAM PR0514590 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO519564 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO509443 EE0000000-HAZ MAT SJC OES Inactive Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0534087 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Me undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific.PHS/EHD hourty 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 Ordinate Codes anNor Standards and <br /> State armor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment Type Check Number Received b <br /> REHS: ^4 • A43q>t � Date 5 I S / I r Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />