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[Record <br /> :terun 5/22/2009 10:48:27AI SAN JOIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Pagel <br /> Facility Information as of 5122120 <br /> Selection Criteria: Facility ID FA0007299 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0006008 New Owner ID <br /> Owner Name PIEDMONT LUMBER& MILL CO INC <br /> Owner DBA PIEDMONT LUMBER& MILL CO INC <br /> Owner Address 395 TAYLOR BLVD STE 225 <br /> PLEASANT HILL, CA 94523 <br /> Home Phone 510-674-8770 <br /> Work/Business Phone 510-674-6770 <br /> Mailing Address 395 TAYLOR BLVD STE 225 <br /> PLEASANT HILL, CA 94523 <br /> Care of PIEDMONT LUMBER& MILL CO INC <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0007299 <br /> Facility Name PIEDMONT LUMBER& MILL CO INC <br /> Location 7777 W 11 TH ST <br /> TRACY, CA 95376 <br /> Phone 510-674-8770 <br /> Mailing Address 395 TAYLOR BLVD STE 225 <br /> PLEASANT HILL, CA 94523 <br /> Care of PIEDMONT LUMBER& MILL CO INC <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 005- ORNELLAS, LEROY Fax <br /> APN EMail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name PIEDMONT LUMBER& MILL CO <br /> Title <br /> Day Phone 510-674-8770 <br /> Night Phone 510-674-8770 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0010793 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name PIEDMONT LUMBER & MILL CO INC (Circle One) <br /> Account Balance as of 512212009: $0.00 <br /> (Circle One) <br /> Transfer to Active)lnactve <br /> Program/Flement and Description Record ID Employee ID and Name Status New Owner'? Delete <br /> 2381 -UST FACILITY(BEFORE 1184)-obsolete PR0506242 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARrPR0507665 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the 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. 1 also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws_ <br /> pp,()�g 2--Ci �-1 Zf � � raD `t (/f l 4 � 2J f 1, > L1/i>✓' � <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date I I <br /> Payment Type Check Number Received by _ <br /> RENS: Date t 1 Account out: L Date ! - <br /> COMMENTS: <br /> lleh-envlenvisionlreports15021.rpt <br />