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Date run 1/2/2003 12:16:44PM SAN JyC(`NQUIN COUNTY ENVIRONMENTAL HEA T'TH DEPARTMENT Report#5021 <br /> Run by al Facility Information as of 1/2/"Ne& <br /> el <br /> Record'Selection Criteria: Facility ID FA0011033 <br /> Make changes/corrections in RED Ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0009033 Case Number: H09191 New Owner ID <br /> Owner Name STOCKTON INTERTRANS CORP <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-462-8700 <br /> Mailing Address 5000 S AIRPORT WAY <br /> STOCKTON, CA 952 <br /> Care of <br /> FACILITY FILE INFORMATION /' <br /> / <br /> Facility ID FA0011033 v/ <br /> Facility Name YELLOW CAB CO <br /> Location C E DIXON ST For <br /> STOCKTON, CA 95206 -70 J0 S I!�r l 0>1 <br /> Phone 209-462-8700 <br /> Mailing Address 5000 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Care of STOCKTON INTERTRANS CORP <br /> Location Code 01 -STOCKTON APN:177-260-25 <br /> BOB District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0018033 ewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / F chilly / Account <br /> Account Name YELLOW CAB COMPANY C One) <br /> Account Balance as of 1/2/2003: $0.00 <br /> (Circle One) <br /> Transferee Active <br /> New Owner? Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2220- <5 TIYR. PR0514501 EEOOO0000-HAZ MAT SJC DES Active Y N D <br /> 2224-H J T N<5 O PLAN AUTHORIZATIO PR0513321 EE0000000-HAZ MAT SJC DES Active Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPRO511033 EE0000000-HAZ MAT SJC OES Active Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I.the undersigned owner,operator or agent of same,acknoMecige that all site,anNor project specift,PHS/EHD hourly charges assocGWWfth this <br /> (achy or activity will be billed to the party Memm ed as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State andfor 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 Received <br /> lly REHS: Date I / Account out: Date fl D 3 <br /> COMMENTS: \ <br /> 100lgd-gZ ( {c i ✓% J <br /> aa� 70I - o0'� Lf <br /> a��� Q2 o SJ 9 0qS <br /> , 32 <br /> \\Phs-ehsgl-nl\apps\Envisions\Reports\5021.rpt `� <br />