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Date run : 5/26/00 2:39:03PM SAV )AQUIN COUNTY PUBLIC HEALTH SEI SES Report #: 0002 <br /> Run by VPEDRAZA Facility Information as of 5/26/00 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0010989 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0008989 Case Number: H09109 New owner ID <br /> Owner Name: VERN DALE MCPHERSON <br /> Owner DBA' <br /> Owner Address' <br /> Home Phone: Not Specified g470 <br /> Work/Bussness Phone: 209477-0399-6/ <br /> 09-477-0399 (,1 , <br /> Mailing Address: PO BOX 6906 K <br /> Care of: <br /> FACILITY FILE INFORMATION <br /> Facility to: FA0010989 d�Gw/ j//w�� ��� /hQr vve,-,f, <br /> Facility Name: MCPHERSON FNITFRPRISE FAB & MAINT IIP <br /> Location: 280 E ARMSTRONG RD / <br /> LODI, CA 952429420 �l/S /2r S i/e SS /1v ����Q✓_ <br /> Phone: 209-333-8716 C <br /> Mailing Address: 280 E ARMSTRONG RD /li(;diY��`. - c 'All <br /> Care of: VERN DALE MCPHERSON <br /> Location Code: 02 - LODI APN; 059-020-12 <br /> Bos District: 004- SEIGLOCK, JACK SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0017989 New Account ID:: <br /> Mail Invoices to: Account Mail Invoices to: Owner/Facility/Account <br /> Account Name: MCPHERSON ENTERPRISE FAB & MAI NT (Circle One) <br /> Account Balance as of 5/26/00: $110.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inaelve <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO514485 EE0006213-PEDRAZA Active Y N A 77 D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FI PRO510989 EE0000000-SJC DES Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513277 EE0000000-SJC DES Active Y N A I I D��1J <br /> l� <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agentof same,acknowledge thataB site,sari/or <br /> project specific,PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILIYNG PARTY on this <br /> form. I also certify that a6 operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal <br /> Laws. <br /> APPLICANT'S SIGNATURE: Date I / <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date / I <br /> Payment Type Check Number Receipt Number Received by �[T <br /> REHS: Date / / Account out: Date 04, l �y✓ l(/v ' <br /> 1.0.0.69.00 <br />