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Date run 8/26/2010 12:11:38PI SAN JUIN COUNTY ENVIRONMENTAL HE. - DEPARTMENT Report #5021 <br />Run by Pagel <br />Facility Information as of 8/26/2ul b <br />rcecora aetection cntena: reality iu I-AU01 bl b9 <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 />BOIS District 001 - VILLAPUDUA <br />APN 14503009 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE(date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />QEcoLbUY SToc�t>^Coc1 <br />0135 &A, FIRST ST. <br />17l Xat" , Ck q5G 26 <br />407.698-I57$ <br />101-4"-y65- 3c� <br />5o, Inn E <br />_ RE�o�.�y STeC—k To <br />Aso polzT ROAD 23 <br />S-rb c -k -To I`1, CA q59 -c>6 <br />atxf� Y6S-3oo� <br />.235- M. F)v--,-rST <br />ct56ay <br />Alt Phone <br />Fax <br />EMail : <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name ERIC HORTON PAYMENT'' E <br />Title <br />Day Phone 209-456-1145 RECEIVED zaj, e <br />Night Phone 209-955-1516 AUG 2 6 2010 <br />ACCOUNTS RECEIVABLE FILE INFORMATION SAN JOAQUIN COUNTY <br />ENVIRONMENT <br />Account ID AR0028312 <br />HEALTH DEPA,9TIVENew Account I <br />VT D <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 />Program/Element and Description Record ID Employee ID and NameTransfer to Active/Inactve <br />Status N Owner? Delete <br />2220 - SM HW GEN <5 TONS/YR PRO526359 EE0008317 - RAYMOND VON FLUE Active Y N A I D <br />2244 - PACT TRANSFER RECORD - OES PRO524098 Active Y N A I D <br />AST FAC 10 K - </=100 K GAL CUMULATIVEPRO528528 EE0008317 - RAYMOND VON FLUE Active N A Q D <br />4740 - WASTE TIRE SITE - EXEMPT PRO524592 EE0004045 - TED TASIOPOULOS Active (Y J N A I D <br />ERSC - ELECTRONIC REPORTING SURCHARGE PR0532619 Active <br />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 Ordinace Codes and /or Standards and <br />State and/or Federal Laws. <br />APPLICANT'S SIGNATURE: Date <br />t <br />c� <br />Program Records to be TRANSFERED: a <br />$20.00 = ? Amount Paid ae Date <br />Water System to be TRANSFERED: ` $372.00 = Amount Paid / t�� <br />Payment Type Date <br />Y YP Check Number Received by�� �v\ <br />REHS: _ <br />COMMENTS: �� Date _�/ ��/_� Account out: D to <br />Av, <br />11eh-env\envisionlreports15021.rpt PK +�� J r- (r e k' J\ f1/1 <br />�„ �- ��T <br />