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Dale run 8/26/2010 12:11:38PI SAN,` 2UIN COUNTY ENVIRONMENTAL HE' ' H DEPARTMENT Report #5021 <br />Run by Pagel <br />Facility Information as of 8/26/x„ r 0 <br />Kecora seieceon cntene: FaGnty ID FA0016159 <br />OWNER FILE INFORMATION <br />Owner ID OW0013085 <br />Owner Name A PLUS MATERIALS RECYCLING INC <br />Owner DBA A PLUS MATERIALS RECYCLING INC <br />Owner Address 2710 LOOMIS RD <br />STOCKTON, CA 95205 <br />Home Phone 209-462-9168 <br />Work/Business Phone 209-939-1315 <br />Mailing Address 2710 LOOMIS RD <br />STOCKTON, CA 95205 <br />Care of <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE(date) C <br />OWNERSHIP CHANGE(date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Q>GLoLOC�Y S-�oC.�T(�C1 <br />a35 AA • Ft tz l r ST• <br />pt xor t 'CA 95G R6 <br />407.698 -I5?-d <br />101-46{-y65-3C:)� <br />Sc�.wtE <br />FACILITY FILE INFORMATION <br />Facility ID FA0016189 <br />Facility Name APLUS MATERIALS RECYCLING INC RE4-0L-�y STeC-kToQ <br />Location 250 PORT RD # 23 95 0 !Oo RT fZ.oA D 7-S <br />STOCKTON, CA 95205 Svc-k-Tbti1, CA 955 <br />Phone 209-939-1315 a CX'4 ^ Yb S - 302`7 <br />Mailing Address 2710 LOOMIS RD .235 /tel. FIRST ST <br />STOCKTON, CA 95205 VI XOM t CA Ct56o20 <br />Care of <br />Location Code 01-STOCKTON Alt Phone <br />BOS District 001 - VILLAPUDUA Fax <br />APN 14503009 EMail: <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name ERIC HORTON PAYMENT `5AvA E <br />Title RECEIVED <br />Day Phone 209-456-1145 inn IE <br />Night Phone 209-955-1516 AUG 2 6 2010 S�.tr"' c -- <br />ACCOUNTS RECEIVABLE FILE INFORMATION SAN JOAQUIN COUNTY <br />Account ID AR0028312 H ENVIRONMENTAL New Account ID <br />EALTH DEPARTMENT <br />Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br />Account Name A PLUS MATERIALS RECYCLING INC (Circle One) <br />Account Balance as of 8/26/2010: $0.00 <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status Ne Owner? Delete <br />2220 - SM HW GEN <5 TONS/YR PR0526359 EE0008317 - RAYMOND VON FLUE Active Y N A I D <br />2244 - PACT TRANSFER RECORD - IDES PR0524098 Active Y N A I D <br />83 AST FAC 10 K - </=100 K GAL CUMULATIVEPRO528528 EE0008317 - RAYMOND VON FLUE Active s N A © D <br />4740 - WASTE TIRE SITE - EXEMPT PR0524592 EE0004045 - TED TASIOPOULOS Active (Y J N A I D <br />ERSC - ELECTRONIC REPORTING SURCHARGE PR0532619 Active 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 specific, 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 Ordinate Codes and /or Standards and <br />State and/or Federal Laws. <br />APPLICANT'S SIGNATURE: �� , fV 1— Date ��/�/ �� - �stu� <br />a <br />Program Records to be TRANSFERED: ' $20.00 = c� (2 /—Amount Paid aB — Date _�/ �_ ) ` ��c 3(a <br />Water System to be TRANSFERED: ' $372.00 = Amount Paid Date� <br />Payment Type Check Number Received by <br />REHS: Date �_// [ d Account out: D6 <br />COMMENTS: 7` <br />j�\\eh-env\envision\reports\5021 rpt C� �� �1 L)� <br />