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Repoli p5021 <br /> Date mn 2/27/2004 2:57:21PN SAN JOAC -N COUNTY ENVIRONMENTAL HEALTT'pEpARTMENT Pagel <br /> Ren Date; <br /> �"' Facility Information as of 2/2712004--- <br /> Base.Record man.: Facility ID FA0013436 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0010574 New Owner ID <br /> Owner Name KUNTZ, ELDON I JUDY <br /> Owner DBA <br /> Owner Address 1611 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-464-7383 <br /> Mailing Address 1611 S AIRPORT WAY <br /> STOCKTON, CA 952062322 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013436 f f}S � 3 <br /> Facility Name CHARTER WAY SALVAGE <br /> Location 1020 E CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-941-0761 <br /> Mailing Address 1611 S AIRPORT WAY <br /> STOCKTON, CA 952062322 <br /> Care of WEST LANE TOWING <br /> Location Code 01 -STOCKTON APN:16902004 <br /> BOS District SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022455 / NewAccount ID: <br /> Mail Invoices to Facility _ - Mail Invoices to: Owner / Facility / Account <br /> Account Name CT!T <br /> C> � � (Circle One) <br /> Account Balance as of 2/27/ C� <br /> (Circle One) <br /> Transfer to AeWelIMCNe <br /> Pragram/ElemeM and Description Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0517457 EE0008844-DINA ABATE Active Y N A <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO517564 EE0000o00-HAZ MAT SJC DES Active Y N AD <br /> 2244-PACT TRANSFER RECORD-DES PRO521147 EE0000000-HAZ MAT SJC DES Inactive Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0517458 EE0007289-ALISON YOUNGBLOODlnactive 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 Nis <br /> facility er acbwity 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 an applicable Ordinate 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 Date <br /> Payment Type Check Number Received by <br /> REHS: Date_/ ! Account out: Date -P-- <br /> COMMENTS: <br /> \\Phs�hsgl-nt\apps\Envisions\Reports\5021.rpt <br />