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Date run 1/22/2004 12:44:09PI SAN J0 A 7UIN COUNTY ENVIRONMENTAL HEA' "''I DEPARTMENT Report#5021 <br /> Run by — Pagel <br /> ,Facility Infor ation as of 1/22/2 _ , <br /> Record Selection Criteria: Facility ID FA0002636 <br /> Make changes/corrections in RED ink or pencil. <br /> \ INFORMATION CHANGE(date) <br /> 1\J�` OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002000 New Owner ID <br /> Owner Name BRESCIANI, JOHN C <br /> Owner DBA WINDMILL COVE MARINA& RV PARK <br /> Owner Address RK 6 7� <br /> RE-TAkWNVq:QA, 94 23107 �a`��1� <br /> Home Phon �1�5 <br /> Work/Business Phone -948-g995 `0I�— <br /> Mailing Address 7600 WINDMILL COVE RD <br /> STOCKTON, CA 95206 C' �- <br /> Care of JOHN BRESCIANI <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0002636 <br /> Facility Name WINDMILL COVE MARINA& RV PARK <br /> Location 7600 WINDMILL COVE RD <br /> STOCKTON, CA 95206 <br /> Phone 209-948-6995 <br /> Mailing Address 7600 WINDMILL COVE RD <br /> STOCKTON, CA 95206 <br /> Care of JOHN C BRESCIANI <br /> Location Code 01 - STOCKTON APN:13122008 <br /> BOS District SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0002414 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name WINDMILL COVE MARINA& RV PARK (Circle One) <br /> Account Balance as of 1/22/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1625-RESTAURANT/BAR 51-100 SEATS PRO160819 EE0003361 -MARIBEL FLOHRSCHUTActive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO512312 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520032 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PR0516784 EE0000008-LETITIA BRIGGS Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0510024 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4654-TNC WATER SYSTEM(QRTLY)W/TX WA0460616 EE0000753-WILLIE NG 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 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 /> APPLICANT'S SIGNATURE: % _ Date <br /> Program Records to be TRA FERED: *$20.00= Amount Paid Date ! / <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Check Number Received by <br /> REHS / Date_�/ _! d Account out: Date <br /> COMMENTS: JJ t <br /> 01-d - S C-'-� / Yl D <br /> \\P hs-ehsq I-nt\apps\Envisions\Reports\5021.rpt <br />