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Date mn 10/27/2005 9:30:42A SAN JOA 'IN COUNT)(ENVIRONMENTAL HEAL DEPARTMENT Report #5021 <br />Run by Pagel <br />F <br />Facility Information as of 10/27/2005 <br />Record Selection Criteria: Facility ID FA0013511 <br />OWNER FILE INFORMATION <br />Owner ID OW0010640 <br />Owner Name <br />Owner DBA <br />Owner Address . <br />JIN <br />d� <br />55414 <br />Home Phone Not Specified <br />NoNNE Specified <br />Work/Business Phi <br />Mailing Address 610 KASOTA AVE <br />MINNEAPOLIS, MN 55414 <br />Care of <br />FACILITY FILE INFORMATION <br />FacilityID FA0013511 <br />Facility Name SPECTRUM INDUSTRIAL SVCS INC <br />Location 4025 E ARCH RD <br />STOCKTON, CA 95215 <br />Phone –209_46a=�1✓iC <br />Mailing Address <br />Care of <br />Location Code <br />BOS District <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0022615 <br />Mail Invoices to Facility <br />Account Name SPECTRUM INDUSTRIAL SVCS INC <br />Account Balance as of 10/27/2005: $0.00 <br />Pmgram/Elem arl and Description <br />Record ID Employee ID and Name <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />New Owner ID <br />.►' _ .0 Ili <br />909- 3- y2el- <br />5- /,!/yc/y R 0 <br />To c p;5 'TDA( C'✓A 9 2 t T <br />�-G'9- <br />�1l01.'S'-Al2c �9 <br />APN:17926014 <br />SIC Code:9900 <br />New Account ID: <br />: - --- <br />Mail Invoices to: Owner Facility Account <br />e One) <br />Transfer to (Circle One) <br />Activa/Inacive <br />Status New Omer? Delete <br />2220 - SM HW GEN <5 TONS/YR PRO517583 EE0002670 - MUNIAPPA NAIDU Active Y N A I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO517585 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D <br />2244 - PACT TRANSFER RECORD - DES PRO520942 EE0000000 - HAZ MAT SJC DES Active Y N A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARIPR0517584 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 spec, 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 Ordinate Codes andler Standards and <br />State anwor Federal Laws. ,r O ,r <br />APPLICANTS SIGNATURE: J Date //) / 2 ?1/ 615— <br />Program <br />sProgram Records to be TRANS FERED: ' $20.00 = Amount Paid Qb. 00 Datet 0/c19_/05 <br />Water System <br />Payment Type to be TRANSFERED:Check Number $372.00 = Amount Paid Date <br />Received by <br />REHS: `�.3 Date 0I _ 1O /L—_SL/ O <br />Account out: Date <br />COMMENTS: <br />�e--\ <br />NV":,V UQV-a \0`1IIbS—\2-1&V0-5 <br />W# )3gotf <br />1\phs-ehsq I-nt\apps\envisions\reports\5021. rpt <br />PAYMENT <br />RECEIVED <br />OCT 2 7 2005 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />