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Date ran 10/4/2004 2:25:37Ph SAN JO "N COUNTY ENVIRONMENTAL HEA' 7EPARTMENT Report#5021 <br /> Run by �\� Pagel <br /> Facility Information as of 10Y4/200e <br /> Record Selection Criteria: Facility ID FA0009240 <br /> Make changes/corrections In RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION ' --- -- <br /> Owner ID OW0007240 Case Number: H02322 New owner ID <br /> Owner Name PATEL, GIRA <br /> Owner DBA ELITE CLEANERS <br /> Owner Address 3208 AUTUMN CHASE CIR <br /> STOCKTON, CA 95219 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-957-9361 <br /> Mailing Address 3201 W BENJAMIN HOLT DR#119 <br /> STOCKTON, CA 95219 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009240 <br /> Facility Name ELITE CLEANERS <br /> Location 3201 W BENJAMIN HOLT DR 119 <br /> STOCKTON, CA 95219 <br /> Phone <br /> Mailing Address 3201 W BENJAMIN HOLT DR#119 <br /> STOCKTON, CA 95219 <br /> Care of <br /> Location Code 01 -STOCKTON APN:10017009 <br /> BOS District 002-MARENCO, DARIO SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016240 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ELITE CLEANERS (Circle One) <br /> Account Balance as of 10/4/2004; $0.00 <br /> Transfer to (Circle One) <br /> Prog un/Element and Description Retard 10 Employee ID and Name Status ellateate New Owner? ACCrve e <br /> 2220-SM HW GEN<5 TONSNR PR0513720 EE0003580-MICHELLE LE Active Y N A j D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO511528 EE0000000-HAZ MAT SJC DES Inactive Y N A (._ D <br /> 2244-PACT TRANSFER RECORD-DES PRO520909 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPRO509240 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,acknoWedge that all site,and/or project speck,PHS/EHD hourly charges associated this <br /> facility or activity Wit be billed to the party idanBfled as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standar and <br /> Slate and/or Federal Laws. <br /> APPLICANTS SIGNATURE: (� Date /0 / 4 / 09, 0 <br /> up <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be T S ERED: '$155.00= Amount Paid Date <br /> Payment Type heck ber Received by D�j i5 <br /> REHS: e / / Account out: Date 10 <br /> COMMENTS: <br /> OCT 4 2004 <br /> ENPERM,,SERVICES H <br /> \\phs-ehsgl-nftapps\env6sions\reports\5021,rpt <br />