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Dale nn 1/3/2011 3:11:01PM SAN JO' N COUNTY ENVIRONMENTAL HEA*EPARTMENT <br /> Report#5021 <br /> Pagel <br /> Run by Facility Information as of 1/3/2011 <br /> Record Selection Criteria: Facility ID FA0012555 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0009755 New Owner ID <br /> Owner Name OATES, MARVIN L <br /> Owner DBA BUZZ OATES ENTERPRISE <br /> Owner Address 8615 ELDER CREEK RD <br /> SACRAMENTO, CA 95828 <br /> Home Phone 916-381-3600 <br /> Work/Business Phone Not Specified <br /> Mailing Address 8615 ELDER CREEK RD <br /> SACRAMENTO, CA 95828 <br /> Care of MARVIN OATES <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012555 <br /> Facility Name BUZZ OATES ENTERPRISE <br /> Location 1501 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Phone <br /> Mailing Address 8615 ELDER CREEK RD <br /> SACRAMENTO, CA 95828 <br /> Care of MARVIN OATES <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16902011 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MARVIN OATES <br /> Title <br /> Day Phone 916-381-3600 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0020662 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility ! Account <br /> Account Name LOWNEY ASSOCIATES (circle One) <br /> Account Balance as of 1/3/2011: $0.00 (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PRO516318 EE0000997-HARLIN KNOLL Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Me undersigned owner,operator or agent of same,acknowledge that all site,and/or Project specific,PHSIEHu hourly charges associated with this <br /> facility or activity will be billed to the party identilied as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ort inace Codes and/or Standards and <br /> State andfor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> RENS: Date_/ /_ Account out: Date <br /> COMMENTS: <br /> \\eh-env\envisionVeports\5021.rpt <br />