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Date run 8/26/2010 12:11:38PI SAN JUIN COUNTY EN', lRONMENTAL HE2 .DEPARTMENT Report #5021 <br />Run by Pagel <br />Facility Information as of 8/26/2010 <br />r ccora oetecuon untena: t-acmty w 1-AU016189 <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 />FACILITY FILE INFORMATION <br />Facility ID FA0016189 <br />Facility Name A PLUS MATERIALS RECYCLING INC <br />Location 250 PORT RD # 23 <br />STOCKTON, CA 95205 <br />Phone 209-939-1315 <br />Mailing Address 2710 LOOMIS RD <br />STOCKTON, CA 95205 <br />Care of <br />Location Code 01-STOCKTON <br />BOS District 001 - VILLAPUDUA <br />APN 14503009 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE(date) <br />OWNERSHIP CHANGE(date) 9 <br />SSN / Fed Tax ID <br />New Owner ID : <br />QEGOLCX;Y SToc KTo� <br />oZ35 /11. �1 RST ST <br />17txot'l, 'C -As 45 ba q5(' 26 <br />107 <br />A09 - 4" - y65 -3666'! <br />5o.wtE <br />RE�ot..cX.�Y STe�-k Toti1 <br />9,50 ?ORT ROAD Z'3 <br />CA q 5 ap5 <br />aoq^ Y6S-3oo� <br />-23 s til . FI es -r sT <br />DI iryN I if -A ct56ay <br />Alt Phone <br />Fax <br />EMail <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name ERIC HORTON <br />Title PAYMENT -� E <br />Day Phone 209-456-1145 rRECEIVED <br />Night Phone 209-955-1516 AUS 2 6 2019 <br />ACCOUNTS RECEIVABLE FILE INFORMATION SAN JOAQUIN COUNTY <br />Account ID AR0028312 <br />ENVIRONMENTAL New Account <br />HE,',LTH DEPARTMENT ID. <br />Mail Invoices to Facility Mail Invoices to: Owner / Facility / <br />Account <br />Account Name A PLUS MATERIALS RECYCLING INC <br />(Circle One) <br />Account Balance as of 8/26/2010: $0.00 <br />(Circle One) <br />Program/Element and Description Record ID Transfer to <br />Employee ID and Name Status <br />Active/Inaclve <br />N I Owner? <br />Delete <br />2220 - SM HW GEN <5 TONS/YR PRO526359 EE0008317 - RAYMOND VON FLUE Active Y <br />N <br />2244 - PACT TRANSFER RECORD - OES PR0524098 Active <br />A I D <br />Y N <br />2832 - AST FAC 10 K - </=100 K GAL CUMULATIVEPRO528528 EE0008317 - RAYMOND VON FLUE Active�,� N <br />4740 WASTE <br />A I D <br />A ©D <br />- TIRE SITE - EXEMPT PR0524592 EE0004045 - TED TASIOPOULOS Active <br />(Y"J N <br />ERSC - ELECTRONIC REPORTING SURCHARGE PR0532619 <br />A I D <br />Active N <br />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 <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 in <br />associated with this <br />Stale and/or Federal Laws. performed accordance with all applicable Ordinace Codes and <br />/or Standards and <br />APPLICANT'S SIGNATURE: <br />�� <br />Date / r0 / 10 <br />Program Records to be TRANSFERED: * $20.00 = g2(2 / Amount Paid AP - Date <br />Water <br />System to be TRANSFERED: * $372.00 = Amount Paid Date / <br />Payment Type <br />Y YP Check Number <br />Received by <br />RENS: 2� Date _�// I Q Account out: D <br />COMMENTS: to <br />/E)\\eh-env\envision\reports\5021.rpt 1 —7110 lJ -(/ a `lS ( <br />11In "-t <br />