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;ANDY Sari Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 06/09/99 <br /> - - - - -- - - - - --- - - - - - - -- - - - - - ------ - - - - - - --- - - - -- -- --- -- -- -- - - -- <br /> Make changes/corrections in RED pen or pencil: <br /> C iR FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date,: <br /> OWNER :D: 008714 CASE # : H08558 New owner rD: 00 <br /> Owner Name ADVANCED MATERIALS INC <br /> Owner DSA: <br /> Owner Address: <br /> Home Phone: , <br /> Soc Sec# / Tax fD#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address. 20211 S SUSANA RD <br /> Care of: <br /> RANCHO DOMINGUEZ, CA 90221 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 010714 <br /> Facility Name: CONDOR UTILITY PRODUCTS INC <br /> Location: 1450 E SCOTTS AVE <br /> STOCKTON 95205- 20 <br /> Phone: 209-465-0209 <br /> Mailing Address: 1450 E SCOTTS AVE (i^�[/ ( /, J� eahIkI <br /> care ot: CONDOR UTILITY PROD TS <br /> STOCKTON, CA 95205 CA C4 oa <br /> Location Code: APH: 151-310-144 <br /> POS es strict: SIC code: 3087 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION (0 <br /> AcmuNT ID: 0017714 New Account ID: 000 <br /> Mail invm cea to: Account Mail Invoices to: Owner / Facility / Account <br /> Account Name: CONDOR UTILITY PRODUCTS INC :circle one) <br /> Account Balance as of 06/09/99 : $28 . 50 !C ucle ones <br /> Record UST(e) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new ownez7 Delete <br /> ---- - --------------- - ------ ---- ----- ------------- -- - -- ---- - ------------------- - <br /> 2399 UNIFIED PROGRAM FAC STATE SERV 510711 0000 SSC DES ACTIVE y N A I D <br /> 2221 Mz MAT BUSINESS PLAN AUTHORIE 513002 0000 SJC OES ACTIVE y N A I D <br /> ------------------- ---- ------- ------------------------ ------------------------- <br /> BILLING and COMPLIANCE ACRNOMLEWEMENT: 1, the undersigned owner, operator or agent of some, acknowledge that all Its and/or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be hilled to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in aCcord.ance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal taws. <br /> APPLICANT'S SIGNATURE: Date <br /> _^.------ - ---------------- ------- -------- ---- -- - ------ -------- - - - - -- -- -- - - - - --- <br /> Records to be TRANSFERED: z $20.00 ` Amount Paid Date_ <br /> Water System to be TRANSFERED: x 5150.00 - Amount Paid Date_ <br /> Payment Type Check # Recvd by <br /> ---------- -- -- -- - ------------------------ -- -- - - - - -- - - --- - - --- <br /> BEHR cr COUNTER SUPV: Date_/_/_ ACCT nu[: Date __/ / UNIT/File:_/_/_ <br />