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Date run 10/1/2008 1:12:01PA SAN JO fIN COUNTY ENVIRONMENTAL HEAR DEPARTMENT Report#5`21 <br /> Run by 4006 Pagel <br /> Facility Information as of 10/1/2 <br /> Record Selection Criteria: Facility ID FA0014457 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID <br /> Owner ID OW0011499 New Owner ID <br /> Owner Name KEN &CINDY BOYD <br /> Owner DBA BOYD'S DRIVE LINE SVC OF STKN <br /> Owner Address 1900 HERNDON RD �C <br /> CERES, CA 95307 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-538-8956 <br /> Mailing Address 1900 HERNDON RD SAN,Io4g, <br /> CERES, CA 95307 Fff1GEOFfMFR6E;c UN'�— <br /> Care of �FRV/r, <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014457 <br /> Facility Name BOYD'S DRIVE LINE SVC OF STKN <br /> Location 731 E MINER AVE <br /> STOCKTON, CA 95202 <br /> Phone 209-944-9966 xO <br /> Mailing Address 1900 HERNDON RD <br /> CERES, CA 95307 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 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 AR0024537 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name KEN &CINDY BOYD (Circle One) <br /> Account Balance as of 10/1/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omen Delete <br /> 2244-PACT TRANSFER RECORD-OES PR0519315 EE0000000-HAZ MAT SJC OES Active Y 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 spec,PHS/END hourly charges associated with this <br /> facility or activity will be billed to the party Identified as the OWNER on this form. I also sandy that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State anNor 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 /> \\phs-ehsgl-nt\3pps\envisions\reports\5021.rpt <br />