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Date run 4/10/2009 8:36:01AR SAN JO/'�tJIN COUNTY ENVIRONMENTAL HEAL Ty DEPARTMENT Recon#5021 <br /> Run by 5290 `N Pagel <br /> Facility Information as of 4/10/20"e" <br /> Record Selection Criteria: Facility ID FA0013511 <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 OW0010640 New Owner ID <br /> Owner Name PASQUALA&ANGEL'S MARBLE INC <br /> Owner DBA PASQUALA&ANGEL'S MARBLE IN <br /> Owner Address 2211 N JACK TONE RD <br /> STOCKTON, CA 95215 �\ , <br /> Home Phone 209-463-8265 <br /> Work/Business Phone Not Specified \7/\ <br /> Mailing Address 2211 N JACK TONE RD <br /> STOCKTON, CA 95215 <br /> Care of FELICIANO, ANGEL M <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013511 <br /> Facility Name PASQUALA&ANGEL'S MARBLE INC <br /> Location 4025 E ARCH RD <br /> STOCKTON, CA 95215 <br /> Phone 209-463-8265 4 it <br /> Mailing Address 4025 E ARCH RD <br /> STOCKTON, CA 95215 <br /> Care of FELICIANO,ANGEL M <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOB District 002- RUHSTALLER, LARRY Fax <br /> APN 17926014 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name FELICIANO,ANGEL M <br /> Title <br /> Day Phone 209-463-8265 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022615 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name PASQUALA&ANG�L'S MARBLE INC (Cirde One) <br /> : <br /> Account Balance as of 4/10/200 11?Dq, — r� <br /> yD "I W1 ,DrZs � �IZd� (� (Circle One) <br /> } r U c-I[ 'Llahn; TransferOwn to AIXive tete e <br /> Program/Elemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PR0517583 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO517585 EE0000000-HAZ MAT SJC DES Inactive Y N A D <br /> 2244-PACT TRANSFER RECORD-DES PR0520942 EEOOOOOOO-HAZ MAT SJC DES Active Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR PR0517584 EEOOOOOOO-HAZ MAT SJC DES Inactive Y N A 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 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 and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment T e Check Number Received b <br /> REHS: ��i Date�_l_J —/ Qq Account out: Date Zf/,1Q1_0� <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />