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Data run 10/24/2003 4:13:34F .SAN J UIN COUNTY ENVIRONMENTAL HEA I DEPARTMENT <br /> Report#5021 <br /> Run by Nftwr Pagel <br /> Facility Information as of 10/24/2003 <br /> Record Selection Criteria: Facility ID FA0009260 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0007260 Case Number: H02591 New Owner ID <br /> Owner Name RIVER POINT LANDING MARINA RES <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-466-8691 <br /> Mailing Address PO BOX 670 <br /> STOCKTON, CA 95201 <br /> Care of DUNN, RICHARD <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009260 <br /> Facility Name RIVER POINT LANDING MARINA RESORT <br /> Location 4950 W BROOKSIDE RD <br /> STOCKTON, CA 95219 <br /> Phone 209-951-4144 fn7 <br /> Mailing Addressp-- T SOX '1485 <br /> SgFeeKTON, CA 95528ifvn rR Cl lt);Ux =D_ . <br /> Care of RICHARD DUNN <br /> Location Code 01 - STOCKTON APN 016466-000 <br /> BOS District 002 - MARENCO, DARIO SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016260 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name RIVER POINT LANDING MARINA RESORT (Circle One) <br /> Account Balance as of 10/24/2003: $420.00 <br /> (Circle One) <br /> Transfer to ActivellnacNe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO513730 EE0008373-JOHN JACKSON Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511548 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPRO509260 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 party ide ifified as the OWNER on this form. I also caddy that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State 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: '$155.00= Amount Paid <br /> Payment Typ Check Number ��np d by 'o n <br /> REHS: ! Date 11L/ / Account out: Date w/o /[i <br /> COMMENTS: <br /> ^ eZ. <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />