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Date run 4/17/2003 4:47:32PR SAN JOA—TTTN COUNTY ENVIRONMENTAL HEAI )EPARTMENT Report #6021 <br />Run by Page1 <br />`v Facility Information as of 4/17/20t,,s <br />Record Selection Criteria: Facility ID FA0013511 ' <br />\\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION <br />Owner ID OW0010640 <br />New Owner ID <br />Owner Name Ftp\/IRFf C E4NK-RE-GQV.F-E{Y'R.LL <br />Viet l k h Ij(3Yx.) pl.. at RVILe 6 W - <br />Owner DBA SPECTRUM INDUSTRIAL SVCS INC <br />Owner Address 610 SE KASOTA AVE <br />MINNEAPOLIS, MN 55414 <br />Home Phone Not Specified <br />Work(BusinessPhone 612-251-9999 <br />G <br />Mailing Address 610 KASOTA AVE <br />C\ <br />MINNEAPOLIS, MN 55414 <br />Care of <br />FACILITY FILE INFORMATION <br />SPk&7 'k - u n1 iND l!'b Y21/4j, Nc— <br />Facility ID FA0013511 <br />Facility Name <br />_Aa— . A-1— LAM, <br />Location 4025 E ARCH RD <br />f 1�w <br />STOCKTON, CA 95215 <br />Phone 209463-5170 <br />Mailing Address 610 KASOTA AVE <br />MINNEAPOLIS, MN 55414 <br />Care of <br />Location Code <br />APN: <br />BOS District <br />SIC Code:9900 <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0022615 <br />NewAccount ID: <br />Mail Invoices to OWner <br />Mail Invoices to: Owner / Facility / Account <br />Account Name <br />Lt Wt )j4AU61rtIAt (Circle one) <br />Account Balance as of 4/17/2003: $0.00 <br />5 £k VLexls /AO—. <br />, <br />(Circle <br />Transfer to ANe/hu�cbe <br />Program/Element and Description Record ID <br />Employee ID and Name status New Owner? Delete <br />2220 - SM HW GEN <5 TONS/YR PR0517583 <br />EE0008844 - DINA ABATE Active Y N A I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO517585 <br />EE0000000 - HAZ MAT SJC DES Active Y N A I D <br />2244 - PACT TRANSFER RECORD - DES PRO520942 <br />Active Y N A I D <br />2399 - UNIFIED PROGRAM FAC STATE SERVICE FPR0517584 <br />EE0000000 - HAZ MAT SJC DES Inactive 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 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 am <br />State andlor Federal Laws. <br />APPLICANTS SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: ' $20.00 = <br />Amount Paid Date <br />Water System to be TRANSFERED: ' $155.00 = <br />Amount Paid Date <br />Payment Type Check Number <br />by <br />RENS: Date // <br />Account out: Date / o D�n <br />COMMENTS: <br />\\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />