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Datlrun, 4/5/2016 3:06:37PM SAN JG UIN COUNTY ENVIRONMENTAL HES. J DEPARTMENT Report 1115021 <br /> R n by � C ` � _ Pagel <br /> Facility information as of 4/5/2010 <br /> Retard Selection Critet;a: Facility ID FA0005951 <br /> i <br /> a Make changeslcorrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> !.OWNER FILE INFORMATION SSN!Fed Tax ID <br /> Owner ID OW0004744 New Owner ID <br /> Owner Name COHEN, MITCH <br /> Owner DBA PIONEER TRANSPORT, INC <br /> Owner Address 251 E EMPIRE ST <br /> SAN JOSE, CA 95112 <br /> Home Phone 408-287-5800 O <br /> Work/Business Phone 408-287-8099 _ <br /> Mailing Address PO BOX 7 '�-S l - C a_+ � . <br /> l SAN .! E, CA 95112 S So C 5 <br /> h Care of CO N, MITCH <br /> i FACILITY FILE INFORMATION <br /> Facility ID FA0005951 <br /> Facility Name PIONEER TRANSPORT, INC <br /> Location 251 E EMPIRE ST <br /> SAN JOSE, CA 95112 <br /> Phone 800-366-6808 <br /> Mailing Address PO BOX,47 5 I Ix >< <br /> i SAN SE, CA 95103 2 <br /> Care of COHEN, MITCH <br /> Location Code. 01 -STOCKTON Aft Phone <br /> ,I <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name COHEN, MITCH <br /> Title <br /> Day Phone 408-245-2000 <br /> Night Phone 408_735-8118 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0006952 New Account ID: : <br /> I Mail Invoices to Facility Mail Invoices to: Owner / Facility ! Account <br /> Account Name PIONEER TRANSPORT, INC (ciraeone) <br /> Account Balance as of 41512010: $300.00 <br /> !I (Circle One) <br /> Transfer to AchveAnactve <br /> Program/ElemeM and Description Record ID Employee to and Name Status New Owner? Delete <br /> p 4244-PUMPER TRUCK PRO503731 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> s <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner.operator or agent of same,acknowledge that all site,and/or project specific.PHS/EHD hourly charges associated with this <br /> ;j facility or activity w711 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 Ordinate Codes and/or Standards and <br /> t State and/or Federal Laws. <br /> �l <br /> APPLICANT'S SIGNATURE: Date I 1 <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date 1 1 <br /> Payment Ty C eck Number Received by <br /> REHS: 'S !,0 Account out: Date Imo' 1 D <br /> COMMENTS' <br /> Cl'�A yL�ps�./�'�/s+y- 6i�/L S 5 /7�►�.� G0�?tl+sr[S� ti+/l� r7 wYf r�- <br /> Ileh-env\envisionVeportsZ021.rpt <br />