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Date run 6/6/2002 11:15:21AM SAN JOA�'r/IN COUNTY ENVIRONMENTAL HEALTU DEPARTMENT <br /> Run by Report#5021 <br /> *W Facility Information as of 6/6/2002 / Pagel <br /> Record selection Criteria: Facility ID FA0010721 F I L6� <br /> Make changes/corrections in RED Ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0008721 Case Number: H08572 New Owner ID : <br /> Owner Name HELENA CHEMICAL COMPANY <br /> Owner DBA <br /> Owner Address 255 SCHILLING BLVD STE 300 <br /> COLLIERSVILLE, TN 38017 <br /> Home Phone Not Specified <br /> Work/BusinessPhone 901-761-0050 <br /> Mailing Address 6075 POPULAR AVENUE#500 <br /> MEMPHIS, TN 38119 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010721 <br /> Facility Name HELENA CHEMICAL CO <br /> Location 2245 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-465-5777 <br /> Mailing Address 2246 W `"r <br /> Gl-I RTE"WAY X. <br /> {�. 0. �drj X00 0o5 <br /> .A—.. .. Y1�adPate ICA 95358 . OaoL <br /> Care of LUIS SALAICES <br /> Location Code 01 -STOCKTON APN:163-360-17 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017721 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name HELENA CHEMICAL CO (Circle One) <br /> Account Balance as of 6/6/2002: $133.50 <br /> (Circle One) <br /> Transfer to Activetnacwe <br /> Prograntleemem and DBSMption Record ID Employee ID and Name Status New Omen Delete <br /> 2220-SM HW GEN<5 TONSNR PR0517426 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0513009 EE0000o00-HAZ MAT SJC OES Active Y N A I D <br /> 2226-CaIARP PROGRAM PR0514844 EE0000o00-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0510721 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned avner,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 beed 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 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--(" I O L <br /> COMMENTS: <br /> nAzut- f d ern 4."-{ <br /> \\Phs�hsgl-nt\apps\Envisions\Reports\5021.rpt <br />