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Dale run1/29/2014 9:55:02AK SAN JO,,,;IN COUNTY ENVIRONMENTAL HEAI :DEPARTMENT Report a5021 <br />Run X' �i/ �� Pagel <br />Facility Information as of 1/29/2014 <br />Record Selection Criteria. Facility ID FA0016198 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0013094 <br />Owner Name <br />REBECCA FLEENOR <br />Owner DBA <br />FLEENOR COINC <br />Owner Address <br />4201 E FREMONT ST <br />Active Y N A I D <br />STOCKTON, CA 95215 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />510-517-8792 <br />Mailing Address <br />PO BOX 14438 <br />OAKLAND, CA 94614 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility lD/CERS ID <br />FA0016198 10185103 <br />Facility Name <br />FLEENOR CO INC <br />Location <br />4201 E FREMONT ST <br />STOCKTON, CA 95215 <br />Phone <br />510-517-8792 x0 <br />Mailing Address <br />PO BOX 14438 <br />OAKLAND, CA 94614 <br />Care of <br />Location Code 99 - UNINCORPORATED P <br />BOS District 002 - RUHSTALLER, LARRY <br />APN 14327045 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0028321 <br />Mail Invoices to Owner <br />Account Name REBECCA FLEENOR <br />Account Balance as of 1/29/2014: $0.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) Z <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New Owner lD : <br />Alt Phone <br />Fax <br />EMail: <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />APPLICANTS SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment?!! Check Number Reed by <br />RENS: �[ L] I�G�->�� Date / 't ill Accountout: JdY_ 1 Date <br />COMMENTS'. <br />N b D P6 227b- �- pkNk <br />(Circle One) <br />Transferto Active/Inacae <br />Program/Element and Description Record ID Employee ID and Name <br />Status New Owner? Delete <br />1921 - HMBP-Regular-Primary Location PR0524107 EE0009817 - ROBERT LOPEZ <br />Active Y N A I D <br />4740 - WASTE TIRE SITE - EXEMPT PR0526311 EE0002622 - BENJAMIN ESCOTTO <br />Active Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PRO534424 <br />Inactiv( Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andor project specific, PHS/EHD hourly charges associated with this facility <br />or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be perfoaned in accordance with all applicable <br />Ordinance Codes ander Standards and State ands <br />Federal Laws. <br />APPLICANTS SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment?!! Check Number Reed by <br />RENS: �[ L] I�G�->�� Date / 't ill Accountout: JdY_ 1 Date <br />COMMENTS'. <br />N b D P6 227b- �- pkNk <br />