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Date con 2/8/2007 2:28:34PM SAN JOA^XJIN COUNTY ENVIRONMENTAL HEALT-`DEPARTMENT Report#5021 <br /> Run by 4006 .—.1 Pagel <br /> Facility Information as of 2/8/200 <br /> Record Selection tritena: Facility ID FA0010478 <br /> IIIIIII a" Make changesicorrections 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 34./D A AtOP_t k g. ilL DQ-. <br /> z— <br /> Care of -- -f,9?cT <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 <br /> L-G CKYJ524Q <br /> Care of <br /> Location Code 02 - LODI APN 049-070-58 <br /> BOS District 004-SEIGLOCK, JACK 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 (circle Ore) <br /> Account Balance as of 2/8/2007: $1,050.00 <br /> (circle One) <br /> Transfer to AGNe/Inaclve <br /> PrograMElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO514344 EE0000753-WILLIE NG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512766 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-IDES PRO620375 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0510478 EE0000000-HAZ MAT SJC OES 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 vnlh all applicable Ordlrace Codes and/or Standards and <br /> Stale andlor Federal Laws. h,, n �1 <br /> APPLICANTS SIGNATURE: MALL, �2-7� Date o—l�l 0-7 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: "$372.00= Amount Paid Date / / <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs�hsgl-nt\apps\envisions\reports\5021.rpt <br />