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Date an 5/13/2003 3:38:10PK SANJO/ TJIN COUNTY ENVIRONMENTAL HEN I DEPARTMENT Report#5021 <br /> Run by — �e <br /> Facility Information as of 5/13/2003 Page, <br /> Record SelMiDn Criteria: Facllky ID FA0009869 <br /> Make changes/corrections in RED Ink or panel <br /> /�. INFORMATION„GyAN�iE-d( ate <br /> OW NERSHI �rlpJlTIlR,1IF,1{F-. IJS,tYlJj19L+� 9 <br /> OWNER FILE INFORMATION V <br /> Owner ID OW0007869 Case Number: H05P6New Owner ID <br /> Owner Name o�0 <br /> JM EQUIPMENT CO INC S9 ar <br /> Owner DBA l <br /> Owner Address nn j4G)1JAIQLLtS �MoAESfo <br /> CAR1a cRS ; EU sA c 1`44 h10 <br /> Home Phone �.1�rJ � �f <br /> �-. B Cow <br /> Work/Business Phone r ,�gejd/,_ 3 /hoar) <br /> Mailing Address �. y J Cl {'t., <br /> STA64ff6+-6"5206 3 I <br /> Care of VINCENT VICTORINE <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009869 <br /> Facility Name JM EQUIPMENT CO INC <br /> Location 1245 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-466-0707 <br /> Mailing Address 1245 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Care of VINCENT VICTORINE <br /> Location Code 01 -STOCKTON APN:163-230-34-5 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016869 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name JM EQUIPMENT CO INC (Circle One) <br /> Account Balance as of 5/13/2003: $0.00 <br /> (Circle One) <br /> Transfer to Activeliacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514071 EE0007380-STEVEN SHIH ActiveN A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO512157 EE0000000-HAZ MAT SJC OES Active N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520938 Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509869 EE0o00000-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,andlor project specilk.PHS/EMD hourty charges associated with this <br /> facility or activity will be billed to the parry identllled as the OWNER on this form. I also certiry that all operations mill be performed in accordance with all applicable Ordinate Codes anNor Standards and <br /> State anNor Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: 2 `$20.00= �t6k) Amount Paid Date / / <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date <br /> PaymentT e Check Number Received by <br /> REHS: � 6 G^ (�-t_� Date l I /Ci Accountout: Date_/ <br /> COMMENTS: <br /> c¢cz,'A c crtl9 f'o✓`x Mt`. V t �—�corf^Z. l` tv-, e Dw04 . <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />