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Date run 12118/2002 11:35:531 SAN JC IUIN COUNTY ENVIRONMENTAL AEA-'11 DEPARTMENT Report#5021 <br /> Run by `„/ Pagel <br /> Facility Information as of 12/18/ 2 <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 �/ n <br /> Home Phone Not Specified (/ U <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 jf11,(OV OQ 30 r <br /> Facility Name RIVER POINT LANDING MARINA RESORT <br /> Location 4950 W BROOKSIDE RD <br /> STOCKTON, CA 95219 <br /> Phone 209-951-4144 <br /> Mailing Address PO BOX 670 / <br /> STOCKTON, CA 95201 <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 12/18/2002: $420.00 <br /> (Circle One) <br /> Transfer to Achve/Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO513730 EE0000418-MICHAEL KITH Active Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO511548 EEO000o00-HAZ MAT SJC IDES Active Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509260 EEOOOOOOO-HAZ MAT SJC OES Active Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or prgect specific,PHS/EHD Minty charges associated with this <br /> facility or activity will be billed 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 and/or Standards and <br /> State anNur 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 Date <br /> Payment Type Check Number Receiv d y <br /> REHS: Date / / Account out: Date /n21 <br /> COMMENTS: <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />