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Date run : 3/12/01 8:41:54AM SAN '7AQUIN COUNTY PUBLIC HEALTH SER%'"-ES Report #: 0002 <br /> Run by LBROWN U Facility Information as of 3/12/01 Page #: 1 <br /> 1.W <br /> Record Selection Criteria: Facility ID FA0009094 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID; OW0007094 Case Number: H01103 New Owner ID <br /> Owner Name: JOHN GIANELLI <br /> Owner DBA• <br /> Owner Address: <br /> Home Phone: Not Specified <br /> Work/Bussness Phone: 209-463-0657 v <br /> Mailing Address: 760 W CHARTER WAY <br /> Care of: -- <br /> FACILITY FILE INFORMATION <br /> Facility l : FA0009094 <br /> FaciFacilityFacilityNamee: FARMERS IMPLEMENT EXCHANGE <br /> Location: 760 W CHARTER WAY <br /> STOCKTON, CA 95206 20 `) <br /> Phone: 209-462-4272 �,�C / (/n6/S, <br /> Mailing Address: 760 W CHARTER WAY <br /> STOCKTON, CA 95206- <br /> Care of: JOHN GIANELLI <br /> Location Code: 01 -STOCKTON APN; 163-230-23 <br /> BOS District: 001 -GUTIERREZ, STEVE SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0016094 New Account ID:: <br /> Mail Invoices to: Account Mail Invoices to: Owner/Facility/Account <br /> Account Name: FARMERS IMPLEMENT EX�HANGE (Circle One) <br /> Account Balance as of 3/12/01: $110.00 /pp $/D <br /> (,Q�Q (Circle One) <br /> UST(s) Transfer to Active/Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? l3fte <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FI PR0509094 EE0000000-SJC OES Active Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511382 EE000OOOO-SJC OES Active Y N A D <br /> 2220-SM HW GEN<5 TONS/YR PR0513635 EEO000418-KITH Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,opera`t Yage e,acknowledge that all site,and/or <br /> project specific,PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this <br /> form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal <br /> Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: .$150.00= Amount Paid Date <br /> Paymen Check Number Receipt Number Received by <br /> REHS: Date / / Account out: Date <br /> 1.0.0.89.00 <br />