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Date mm 11/29/2010 10:38:36/ SAN JO UIN COUNTY ENVIRONMENTAL HEAT Y DEPARTMENT Report#5021 <br /> Rw by "I/ Page1 <br /> Facility Information as of 11/29/2 <br /> Record Selection Criteria: Facility ID FA0018753 <br /> Make changes/corrections in RED ink. <br /> F=� OWNERSHIPFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION �� SSN/Fed Tax ID <br /> Owner ID OW0015420 New Owner 10 <br /> Owner Name CHUO SPRING CO LTD <br /> Owner DBA CENTRAL SPRING INC <br /> Owner Address 1616 BOEING WAY <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 118-105-2623 <br /> Mailing Address 1616 BOEING WAY <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018753 <br /> Facility Name CENTRAL SPRING INC <br /> Location 1616 BOEING WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-983-1234 x0 <br /> Mailing Address 1616 BOEING WAY <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOIS District 001 -VILLAPUDUA Fax '70 $ 1 <br /> APN 17713035 EMail: M 44 ZN[4 tf �frN1Gp( SIPy Nc*Corr <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name HIRO SUZUKI <br /> Title PLANT MANAGER <br /> Day Phone 209-983-1234 <br /> Night Phone 510-921-8056 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0033298 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner I Facility I Account <br /> Account Name CHUO SPRING CO LTD (QnleOne) <br /> Account Balance as of 11/29/2010: $0.00 <br /> (Circle One) <br /> Transfer to Actwe/InacNe <br /> P,egrartUElemera and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220 M HW GEN<5 TONS/YR PRO529791 EE0001421-STACY RIVERA Active Y N A I D <br /> 44-PACT TRANSFER RECORD-DES PRO527669 Active Y N A I D <br /> ERSC•ELECTRONIC REPORTING SURCHARGE PR0534526 Active Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ardlor project specific.PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the pant identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State andfor Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records ro be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment Typ Check Number Received by ' r- , \ <br /> REH . Date / / �� Account out Date /fir+ / , <br /> COMMEE/^NN••T//Snn: COO <br /> 20. 1 -5 20� <br /> \\eh-env\envrsion\reports\5021.rpt <br />