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Date run 5/4/2011 12:56:17PM SAN JUIN COUNTY ENVIRONMENTAL HEASI DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of01 I- <br /> Record Selection Criteria: Facility ID FA0017455 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) ZCO <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0014296 New Owner ID <br /> Owner Name PAPE'S MACHINERY INC <br /> Owner DBA PAPE MACHINERY INC <br /> Owner Address 8621 S EL DORADO ST <br /> FRENCH CAMP, CA 95231 <br /> Home Phone Not Specified <br /> Work/Business Phone 541-341-3344 <br /> Mailing Address PO BOX 407 <br /> EUGENE, OR 97440 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017455 <br /> Facility Name PAPE MACHINERY INC <br /> Location 8621 S EL DORADO ST <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-834-4774 <br /> Mailing Address PO BOX 407 <br /> EUGENE, OR 97440 <br /> Care of <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 19320005 EMail : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030337 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name PAPE MACHINERY INC (Circle One) <br /> Account Balance as of 5/4/2011: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 22�SM HW GEN<5 TONS/YR PR0527546 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0525640 Active Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATI\PR0527551 EE0001421 -STACY RIVERA Active Y N A I D <br /> 47,410-WASTE TIRE SITE-EXEMPT PRO528000 EE0002620-ALFONSO ARAMBULA Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0533408 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 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 /> State and/or 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 Typ Check Number Receiv <br /> REH Date `� / /� Account out: Date / O / <br /> COMMAS: <br /> \\eh-env\envision\reports\5021.rpt <br />