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Date rim 1/30/2004 12:00:20PI SAN JOA"UIN COUNTY ENVIRONMENTAL HEAI"'R DEPARTMENT Report x5021 <br /> Run by Pagel <br /> 1.11 Facility Information as of 1/30/20Dd <br /> Record Selection Criteria: Facility ID FA00098 <br /> Make anges/corrections in RED Ink or pencil. <br /> ^n I I I FORMATION CHANGE(date) <br /> OWNER FILE INFORMATI N yV�1'' _" l OWNERSHIP CHANGE(date) <br /> Owner I OW0007886 Case Number: 28 New er ID <br /> Owner Name HN CROOKS <br /> Owner DBA AC <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-333-0030 <br /> Mailing Address 2020 HURLEY WAY STE 340 <br /> SACRAMENTO, CA 958253226 <br /> Care of <br /> FACILITY FILE INFORMATION S--Q-1 Otost-d— t57D5 Y OPS <br /> Facility ID FA0009886 <br /> Facility Name ACE OIL CO (� <br /> Location 20 S CLUFF AVE <br /> LODI, CA 95240 <br /> Phone 209-333-0030 <br /> Mailing Address 2020 HURLEY WAY STE 340 <br /> SACRAMENTO, CA 958253226 <br /> Care of <br /> Location Code 02 -LODI APN:049-090-32 <br /> BOS District 004 -SEIGLOCK, JACK SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016886 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name ACE OIL CO (Circle one) <br /> Account Balance as of 1/30/2004: $0.00 <br /> (circle one) <br /> Transfer to AcWe/InaCNe <br /> Program/Eleni and Description Record ID Employee ID and Name Status New Owned Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514082 EE0008389-DENNIS CATANYAG Active Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512174 EE0000000-HAZ MAT SJC DES Active Y N A D <br /> 2244-PACT TRANSFER RECORD-DES PR0519938 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509886 EE00000o0-HAZ MAT SJC DES Inactive Y N A f I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHS/EHD hourly charges associated with this <br /> fac4ky or activity 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 all applicable Ori mace Codes and/or Standards and <br /> State and/or Federal Lewis <br /> APPLICANTS 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: LA Date 3o /-P� <br /> COMMENTS: VC <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />