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Date run : 7/6/00 11:11:41AM ' JOAQUIN COUNTY PUBLIC HEALTH ' IIVICES Report #: 0002 <br /> Run by vpEDRAZA `✓ Facility Information as of 7/6/00 J Page #: 1 <br /> Record Selection Criteria: Facility ID FA0009886 <br /> Record in <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID; OW0007886 Case Number: H05728 New Owner ID <br /> Owner Name; JOHN CROOKS <br /> Owner DBA: <br /> Owner Address• <br /> Home Phone: Not Specified <br /> Work/Bussness Phone; 209-333-0030 <br /> Mailing Address; 20 S CLUFF AVE <br /> Care of: <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0009886 <br /> Facility Name: ACE OIL CO Lit 4 <br /> Location; 20 S CLUFF AVE Il t �. <br /> LODI, CA 95240 20 <br /> Phone; 209-333-0030 <br /> Mailing Address: 20 S CLUFF AVE <br /> Care of: JOHN CROOKS (JACK) <br /> Location Code: 02- LODI APN; 049-090-32 <br /> BOS District; 004 -SEIGLOCK, JACK SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID; AR0016886 New Account ID:: <br /> Mail Invoices to: Account Mail Invoices to: Owner/Facility/Account <br /> Account Name; ACE OIL CO (Circle One) <br /> Account Balance as of 7/6/00: $0.00 <br /> (Circe <br /> UST(s) Transfer to Acti Inactva <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FI PRO509886 EE0000000-SJC DES Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512174 EE0000000-SJC DES Active Y N A I �D <br /> 2220-SM HW GEN<5 TONS/YR PR0514082 EE0006213-PEDRAZA Active Y N A (:DD J <br /> BELLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or <br /> project specific,PES/EED 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 I I <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: `$150.00= Amount Paid Date <br /> Payment Type Check Number Receipt Number Received by <br /> REHS: Date / / Account out: Date <br /> 1.0.0.89.00 <br />