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Date run 1/2/2003 12:06:04PKA SAN JO UIN COUNTY ENVIRONMENTAL HE DEPARTMENT Report 95021 <br /> Run by Pagel <br /> Facility Information as of 1/2/2 _ <br /> Record Selection Criteria: Facility ID FA0011012 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION / <br /> Owner I OW0009012 Case Number: H09152 New Owner ID : <br /> Owner Name CURTIS MARUYASU AMERICAN INC <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 502-692-2109 <br /> Mailing Address 665 TT R <br /> LEBA 40033 <br /> Care of J <br /> FACILITY FILE INFORMATION n I n t,XP n Q1lIn P� �+ D��P7 <br /> FacilityID FA0011012 OVEN "" - <br /> Facility Name CURTIS MARUYASU USA <br /> Location 4101 N HOLLY DR <br /> TRACY, CA 95376 <br /> Phone 209-836- <br /> Mailing Addres O BOX 1081 <br /> TRACY, CA 95378 <br /> are of CURTIS MARUYASU AMERICA <br /> Locatio Code APN: <br /> BOS Di ' t 0 - S, LER SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0018012 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CURTIS MARUYASU USA (Circle One) <br /> Account Balance as of 1/2/2003: $0.00 <br /> (Circle One) <br /> Transfer to <br /> Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514490 EE0000451 -STEVE SASSON Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO513300 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0511012 EE0000000-HAZ MAT SJC OES 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 speck,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 antl/a 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: '$155.00= Amount Paid Date I / <br /> Payment Type Check Number Received 4y <br /> REHS: Date / / Account out: Date 01/ 95 /05 , <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />