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RDate run + 4/1112002 12:47:08PI SAN JO�A?p�1^TS7•N COUNTY ENVIRONMENTAL HEAL EPARTMENT Report 05021 <br /> un by f ! Pagel <br /> Facility Information as of 4/11/200`= <br /> Record Sebction Criteria: Facility f0 FA0013664 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) l <br /> OWNER FILE INFORMATION <br /> Owner ID OW0010773 New Owner ID <br /> Owner Name ISHERWOOD, ED <br /> Owner DBA <br /> Owner Address 802 N CLUFF <br /> LODI, CA 95240 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified I <br /> Mailing Address 802 N CLUFF <br /> LODI, CA 95240 1 <br /> Care of ED ISHERWOOD <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013664 <br /> Facility Name PROGRESSIVE EQUIPMENT CO C,Q 6�?R d 2,000 461. Ao"—- OSS <br /> Location 802 N CLUFF <br /> LODI, CA 95240 <br /> Phone <br /> Mailing Address 802 N CLUFF <br /> LODI, CA 95240 <br /> Care of JIM BEEMAN <br /> Location Code 02-LODI APN: <br /> SOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> y I <br /> Account ID AR0022821 New Account ID: <br /> Mail invoices to Facility Mail Invoices to: Owner 1 Facility / Account <br /> Account Name PROGRESSIVE EQUIPMENT CO - (Circle One) <br /> Account Balance as of 4/11/2002: $217.50 <br /> / (Circle one) <br /> Transfer to Aative/InacNve <br /> Program/Element and Description Record 10 Employee ID and Name Status Newer? Delete <br /> 2220-SM HW GEN<5 TONSNR PR0518043 EE0000000-HAZ MAT SJC OES Active Y N A D j <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO518045 EE0000000-HAZ MAT SJC OES Active Y N A D <br /> i 2399-UNIFIED PROGRAM FAG STATE SERVICE FPRO518044 EE0000000-HAZ MAT SJC OES Active Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that an site,andlor project t peclik,PHS/EHD hourly charges associated with this <br /> facility or activity wig be billed to the party Identified as the OWNER on this form. I also certify that all operations win be perfof mod in accordance with all applicable Ordinate Codes and/or Standards and z <br /> State and/or Federal Laws. <br /> i <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 Receiv by <br /> RENS: Date ! / Account out: _ Date <br /> COMMENTS: <br /> / <br /> / I <br /> i <br /> i <br /> r <br /> i <br /> \\Phs-ehsgi-nt\apps\Envisions\Reports\5021.rpt <br /> - I <br />