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Date run 8/15/2014 10:39:49AI SAN JOI COUNTY ENV RONMENTAL HEAD EPARTMENT Report(15021 <br /> Pagel <br /> Run by Facility Information as of 8/15/2014 <br /> Record selection Criteria: Facility ID FA0022521 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0020049 New Owner ID <br /> Owner Name KELLY-MOORE PAINT CO. INC. <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 650-592-8337 <br /> Mailing Address 987 COMMERCIAL ST. <br /> SAN CARLOS, CA 94070 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0022521 10481716 <br /> Facility Name Kelly-Moore Paints <br /> Location 3206 E Hammer Ln Ste A <br /> Stockton, CA 95212 <br /> Phone 209-474-3706 X <br /> Mailing Address ATT: ROBERT STETSON, 987 COMMERCIAL <br /> SAN CARLOS, CA 94070 <br /> Care of KELLY-MOORE PAINT CO. INC. <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> New Account ID: <br /> Account ID AR0041201 Mail Invoices to: Owner / Facility / Account <br /> Mail Invoices to Facility <br /> (Circe One) <br /> Account Name Kelly-Moore Paints <br /> Account Balance as of 8/15/2014: $0.00 (Circle One) <br /> Transfer to Active9nactve <br /> Record ID Employee ID and Name Status New Owner? Delete <br /> Program/Element and Descdption - <br /> 1921 -HMBP-Regular-Primary Location PRO539404 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0539403 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> operator or a enl of same,acknowledge that all site,andror project speck.PHSIEHD hourly charges associated with this facility <br /> BILLING end COMPLIANCE ACKNOWLEDGEMENT: I,theun this <br /> owner, p 9 <br /> 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 Ordinance Codes and'or Stantlartls and Stale ndfor <br /> 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 Receivepl <br /> REHS: /'Iy Date_/-6—/ l�I— Account out: Date / l <br /> I <br /> COMMENTS: <br /> (z,, `�a- <br />