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Date run 2!2012014 11:19:19.01 SAN JUIN COUNTY ENVIRONMENTAL HEA T DEPARTMEPagel <br /> NT lsozl <br /> Pagel <br /> Run by"" <br /> Facility Information as of 2/2012014 <br /> Record Selection Crilerix Facility ID FA0001783 " <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011375 New Owner ID <br /> ,;Owner Name HOLMAN INVESTORS LLC <br /> '; Owner DBA HOLMAN INVESTORS LLC <br /> Owner Address 3200 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-956_9303 _ <br /> Mailing Address R-BO96 'r4vt/ �� �" 1Az '� <br /> S��3GI4T-ON 01-'95248 'x. <br /> Care of <br /> -FACILITY FILE INFORMATION <br /> Facility 101 CERS ID FA0001783 10,180,809 <br /> 'Facility Name HOLMAN INVESTORS LLC <br /> Location 3200 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Phone 209-956-9303 x0 <br /> CMailing Address :PO-B&X-8596 �A <br /> STO��fGT-095208 <br /> Care of <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 002- RUHSTALLER, LARRY Fax <br /> APN 12202019 Entail: <br /> EMERGENCY"NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0001783 New Account ID: <br /> Mail Invoices to. Owner Mail Invoices to: Owner 1 Facility / Account <br /> Account Name HOLMAN INVESTORS LLC (Circle One) <br /> Account Balance as of 212012014: $135.00 <br /> (Circle One) <br /> " Transierlo Active/Inactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0521246 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511641 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PRO514570 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PR0220097 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1184)-obsolete PR0503813 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F. PRO507283 EE0000451 -STEVE SASSON Inactive Y N A 1 D <br /> ' 2840-AST EXEMPT FAC <1,320 GAL PR0515780 EE0004636-GARRETT BACKUS Active,! Y N A I D <br /> r ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533108 Inactive Y N A 1 D <br /> 4630-NTNC WATER SYSTEM WA0461084 -EE0005838-ADRIENNE ELLSAESSER Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anrYor project specific,PHSlEHD hourly charges associated with this facility <br /> or acrNity 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 and'or.Standards and'Slate andlor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date / ! <br /> Program Records to be TRANSFERED: `$25.00 Amount Paid Date 1 / <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received by - <br /> REHS: c L Date 2— 12-0 I t`9� .Account out: f� Date -Z-- 1 �!!f I <br /> COMMENTS: i/"1x Y"VL'i t` /� (k! i' P*k,VVa- &Xt 1. I ,rAA^ (ti rl�' .2 `1 I��---k.kv v • �1 s7 YSn Cah <br /> !a F -r l if 1r,t-'q 1A1ic-'> <br />