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Date jun 9119/2014 4:27:35Pk SAN JOr,,RJIN COUNTY ENVIRONMENTAL HEAI�DEPARTMENT <br /> Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/19/2014 <br /> Record Selection Chains: Facility ID FA0020341 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0016699 New Owner ID <br /> Owner Name Dynamic Textile Restoration, Inc <br /> Owner DBA CODE 3 CLEANERS <br /> Owner Address 4527 S B ST <br /> STOCKTON, CA 95206 <br /> Home Phone 925-980-4241 <br /> Work/Business Phone 925-980-4241 <br /> Mailing Address 4527 South B Street <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0020341 10187567 <br /> Facility Name CODE 3 CLEANERS <br /> Location 1588 E MARCH LN <br /> STOCKTON, CA 95210 <br /> Phone 209-952-6333 x <br /> Mailing Address 4527 South B Street <br /> STOCKTON, CA 95206 <br /> Care of Stephen Crotty <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 09614022 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0036328 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name Dynamic Textile Restoration, Inc (Circle One) <br /> Account Balance as of 9/19/2014: $213.00 <br /> (Circle One) <br /> Transfer to Activwlnactve <br /> ProgranvElement and Description Record ID Employee ID and Name status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO535226 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0539238 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0535291 Inactivt Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project specific,PHSIEHD hourly charges associated with this facility <br /> 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 Ordinance Codes andor Standards and Stale andor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date I / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date II <br /> Payment Type Check Number Received by <br /> REHS: Date_/ / Account out: Date_/ / <br /> COMMENTS: <br />