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Date run 10/24/2007 10:40:28/ SAN JUIN COUNTY ENVIRONMENTAL HEH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/24/ 07 <br /> Record Selection Criteria: Facility ID FA0010782 <br /> Make changes/corrections in RED ink or penc'I. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008782 Case Number: H08734 New Owner ID <br /> Owner Name PAPE MACHINERY <br /> Owner DBA PAPE MACHINERY <br /> Owner Address 8855 S EL DORADO ST <br /> FRENCH CAMP, CA 95231 <br /> Home Phone Not Specified <br /> Work/Business Phone 916-922-7181 <br /> Mailing Address 8621 S EL DORADO ST <br /> FRENCH CAMP, CA 95231 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010782 <br /> Facility Name PAPE MACHINERY <br /> Location 8855 S EL DORADO ST <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-983-8122 <br /> Mailing Address 8621 S EL DORADO ST <br /> FRENCH CAMP, CA 95231 <br /> Care of MUMM, JERRY <br /> Location Code 99- UNINCORPORATED AREA APN: <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017782 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name PAPE MACHINERY (Circle One) <br /> Account Balance as of 10/24/2007: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO514416 EE0008317-RAYMOND VON FLUE Active Y N A ' I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO513070 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520488 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR,PR0510782 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0526215 EE0000060-JENNIFER FRASE Inactive 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: `$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date <br /> Payment Type Check Number Receive <br /> REHS: (' ��T�LI J Date 16 / d-�/ Account out: Date <br /> COMMENTS: <br /> P l Q /v ktG�i v ice: 4- <br /> 2 <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />