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Date run 7/7/201-3 12:47:06PM SAN JOAN (COUNTY ENVIRONMENTAL HEALT EPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/7/2014 <br /> Record Selection Criteria: Facility ID FA0020430 <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: 2 SSN/Fed Tax ID <br /> Owner ID OW0016780 New Owner ID <br /> Owner Name METALSA S A C V <br /> Owner DBA <br /> Owner Address 750 N BLACK BRANCH RD <br /> ELIZABETHTOWN, KY 427014503 <br /> Home Phone 540-966-5315 <br /> Work/Business Phone 270-769-7000 <br /> Mailing Address 750 N BLACK BRANCH RD <br /> ELIZABETHTOWN, KY 427014503 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0020430 <br /> Facility Name METALSA <br /> Location 1550 INDUSTRIAL DR <br /> STOCKTON, CA 95206 <br /> Phone 540-966-5315 <br /> Mailing Address 1550 INDUSTRIAL DR <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 17729005 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION /JW IIqg- �✓� �^"'t "i <br /> Contact Name � "f a 1^A `lD Y-) <br /> Title q D Y' r <br /> Day Phone 540-966-5315 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0036483 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ENVIRON INTERNATIONAL CORP (Circle One) <br /> Account Balance as of 7/7/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Na a �{ Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PRO535431 'EE660099f7IMMLIN KNUILL Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor 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 performed in accordance with all applicable Ordinance Codes and/or Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date <br /> Water System to be TRANFERED: Amount Paid Dat / 7 / LT <br /> Payment Type ✓ Check Number /I'7 Y Received by 01" ) <br /> REHS: Date / / Account out: (4e2 Date —7 <br /> COMMENTS: <br />