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Date run 1/30/2004 9:49:3OAh SAN JC" 'sUIN COUNTY ENVIRONMENTAL HEAT T7 DEPARTMENT Report#5021 <br /> Run byPagel <br /> ^Facility Information as of 1/30/21:7l:4 <br /> Record Selection Criteria: Facility ID FA0010376 <br /> Make changes/corrections N C in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008376 Case Number: H07919 New Owner ID <br /> Owner Name TOM S RANSOM <br /> Owner DBA RANSOM PAINTING CO INC <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-957-7686 <br /> Mailing Address P.O. BOX 1282 <br /> STOCKTON, CA 952011282 <br /> Care of <br /> FACILITY FILE INFORMATION - <br /> Facility ID FA0010376 <br /> Facility Name RANSOM PAINTING CO INC <br /> Location 606 S ANTEROS AVE i S>jt( 5 SL. <br /> STOCKTON, CA 95205 <br /> Phone 209-463-1174 <br /> Mailing Address P.O. BOX 1282 <br /> STOCKTON, CA 952011282 <br /> Care of _--- <br /> Location Code 99- UNINCORPORATED AREA APN:1572415-1572416 <br /> BOS District 002 - MARENCO, DARIO SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> AccountlD AR0017376 NewAccountlD: : <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name TOMS RANSOM (Circe,One) <br /> Account Balance as of 1/30/2004: $0.00 <br /> (Circle One) <br /> Transfer to <br /> Aclive/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 220 ^�" �ti�=� PRO514302 EE0008373-JOHN JACKSON —Accton Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO512664 EEO000000-HAZ MAT SJC DES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520283 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0510376 EEOOo000O-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,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 parry Identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State andlor Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: "$155.00= Amount Paid Date / ! <br /> Payment Type Check Number Received by <br /> REHS: Date ! ! Account out: / ,Date 0 /L_ <br /> COMMENTS: - <br /> �Gv1/1�-Q- <br /> GC " �' �T` 00� 2 Z Z O . ���lTV <br /> l\Phs-ehsgl-nt)appstEnvisionslReportst5021.rpt <br />