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ER�rd <br /> 11/13/2007 8:32:46A SAN Jr �QUIN COUNTY ENVIRONMENTAL HE 'TH DEPARTMENT Report x5021 <br /> �/ <br /> Facility Information as of 11/13/ZDU7 Pagel <br /> eleUbn Criteria: Facility ID FA0010428 <br /> Make changes/cofrections in RED ink or pen I. <br /> 1 L E INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008428 Case Number: H08082 New Owner ID <br /> Owner Name IRIS OHYAMA CORP <br /> Owner DBA IRIS INC <br /> Owner Address 11111 80TH AVE <br /> PLEASANT PRAIRIE, WI 531582910 <br /> Home Phone Not Specified <br /> Work/Business Phone 262-612-1000 <br /> Mailing Address 3021 BOEING WAY <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010428 <br /> Facility Name IRIS INC <br /> Location 3021 BOEING WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-982-9100 <br /> Mailing Address 11111 80TH AVE <br /> PLEASANT PRAIRIE, WI 531582910 <br /> Care of <br /> Location Code 01 -STOCKTON APN:17928023 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017428 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name IRIS INC (Circle One) <br /> Account Balance as of 11/13/2007: $0.00 <br /> Transfer to (Circle <br /> nachas <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514323 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512716 EE0000000-HAZ MAT SJC DES Inactive Y N A D <br /> 2244-PACT TRANSFER RECORD-DES PRO520313 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPR0510428 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING antl COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly charges associated with this <br /> facility or activity will be baled to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes undid,Standards and <br /> State andlor Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date_/_I <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date / I <br /> Payment Type Check Number Received by <br /> REHS: ` Gl/�� Date��/�/[T _ Account out: Date_LLI V f <br /> COMMENTS: <br /> n OrL r✓v'(Lv ?12 Z 0 At 6V4 ©v f <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />