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Date mn 6/13/2006 11:52:55AI SAN JC'JUIN COUNTY ENVIRONMENTAL HEA' -H DEPARTMENT Report 45021 <br /> Runts 4006 1%W Pagel <br /> Facility Information as of 6/13/2t�i <br /> Record Selection Criteria. Fadlity ID FA0010261 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHIS <br /> OWNERSHIP CHANG (ee <br /> OWNER FILE INFORMATION AN .1 4 2006 <br /> Owner ID OW0008261 Case Number: H07514 New Owner ID <br /> Owner Name NUTRENAFEEDS FFICEOFEMEPCOLtySERVICE$ <br /> Owner DBA CERRI FEED <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-982-4632 <br /> Mailing Address 2949 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010261 <br /> Facility Name CERRI FEED CO <br /> Location 2949 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-982-4865 <br /> Mailing Address 2949 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code 01 - STOCKTON APN 177-020-07 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017261 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name NUTRENA FEEDS (Circle One) <br /> Account Balance as of 6/13/2006: $0.00 <br /> (Circle One) <br /> Transferto Actiwinact" <br /> Program/Element and Description Record ID Employee ID and Name Status New OwneO Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512549 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0520195 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPRO510261 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <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 /> 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 /> APPLICANTS SIGNATURE: Date / ! <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: -*$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\ohs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />