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Date run 10/29/2003 4:03:33P SAN JOA N COUNTY ENVIRONMENTAL HEAL EPARTMENT Report#5021 <br /> Run by Facility Information as of 1012912 F [ Pagel I I I <br /> Record Selection Criteria: Facility ID FA0014604 -4 11 K I lilt_" t t i %tr <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID &ffm f%TT----. New Owner ID <br /> Owner Name (CHARTER WAY AUTO RECYCLERS VI)IlL.S r9 V&ft VW P 0 <br /> Owner DBA (,� <br /> Owner Address 930 E CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 930 E CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Care of CHARTER WAY AUTO RECYCLERS <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014604 <br /> Facility Name CHARTER WAY AUTO RECYCLERS <br /> Location 930 E CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone <br /> Mailing Address 930 E CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Care of CHARTER WAY AUTO RECYCLERS <br /> Location Code APN:16718305 <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024849 New Account ID: <br /> Mail Invoices to Facility t Mail Invoices to: Owner ! Facility ! Account <br /> Account Name CHARTER WAY AUTO RECYCLERS (Circle One) <br /> Account Balance as of 1012912003: $417.50 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2217-APPLIANCE RECYCLER PR0521509 EE0008844-DINA ABATE Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONSIYR PR0521746 EE0008844-DINA ABATE Active Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this <br /> facility 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 Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I ! <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date 1 ! <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date, 1 1 <br /> Payment Type Check Number R ce' by <br /> RENS: Date 1 ! Account out: Date /171 <br /> COMMENTS: <br /> IIPhs-ehsgl-ntlapps\Envisi ons%Reports15021.rpt <br />