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Date run 5/4/2007 4:13:04PM SAN Jq AOUIN COUNTY ENVIRONMENTAL HEAT TSI DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/4/2Ob7— <br /> RecwtlSelectionCriteria. Facility ID FA0010478 <br /> Make changes/corrections in RED Ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008478 Case Number: H08181 New Owner ID <br /> Owner Name MARK FRATER <br /> Owner DBA R E SERVICE CO INC <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-339-7200 <br /> Mailing Address 3610 AMERICAN RIVER DR STE 112 <br /> SACRAMENTO, CA 958645999 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010478 <br /> Facility Name R E SERVICE CO INC <br /> Location 400 S BECKMAN RD <br /> LODI, CA 95240 <br /> Phone 209-339-7200 <br /> Mailing Address 3610 AMERICAN RIVER DR STE 112 <br /> SACRAMENTO, CA 958645999 / <br /> Care of <br /> Location Code 02 -LODI APN 049-070-58 <br /> BOS District 004-VOGEL, KEN SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017478 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name MARK FRATER tDkae Gnel <br /> Account Balance as of 5/4/2007: $1,256.00 (4 -(C� � <br /> (Girlie One) <br /> Transfer to gdive/Inadve <br /> ProgmrntElement and Description Record ID Employee ID and Name _Status- New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PR0514344 EE0000753-WILLIE NG Active Y N A I ', D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512766 EE0000000-HAZ MAT SJC OES Y N A r D <br /> 2244-PACT TRANSFER RECORD-OES PRO520375 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARlPR0510478 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,ackno.Wedge 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 Me OWNER on this form. I also certify that all operations will be performed In accordance with all applicable Ordmace Codes andlor Standards and <br /> Slate 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 TypeG <br /> Check Number Received by <br /> REHS: L� Date S 1 :5067 Account out: \`d G— Date <br /> COMMENTS: 1 <br /> (67 Lu etiJ4- 1�' S l7 e S � / S OAXY Lz-( . <br /> (�Oo rso� � <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />