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Date run 5/30/2006 12:08:55PI SAN JOAN COUNTY ENVIRONMENTAL HEALT&EPARTMENT Report#5021 <br /> Run by x Pagel <br /> Facility Information as of 5/30/2006 <br /> Record Selection Criteria: Fadlity ID FA0004959 <br /> Make changes/corrections in RED ink or pe ci. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) V <br /> OWNER FILE INFORMATION 11 (I-- <br /> Owner ID OW0003859 New Owner ID <br /> Owner Name O tJ ` <br /> Owner DBA <br /> Owner Address <br /> 6 \�� x l HCl t�cJ r _ A g4.S`1,L <br /> Home Phone Not Specified <br /> Work/Business Phone 2$g=46t-- 87 �� `1 )_z S 1 O 5 5 -. O Lk 1 _. <br /> Mailing Address 1 g-tg-E <br /> STOeff <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004959 1 1 <br /> Facility Name <br /> Location 930 E CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-46e--23fff DL b `j -, q1.3 -- c( u d 1A cil,0o S <br /> Mailing Address 930 E CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code 01 -STOCKTON APN:16718305 <br /> BOS District 001 - GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005401 New Account ID: <br /> Mail Invoices to Owner 11) Mail Invoices to: Owner / Facility / Account <br /> Account Name OCAMPO, ALFONSO_ R- c�7 (Circle One) <br /> Account Balance as of 513012006: $446.00 V `� !! <br /> Transfer to (Circle One) <br /> Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2217-APPLIANCE RECYCLER PRO521509 EE0002670-MUNIAPPA NAiDU Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO517682 EE0002670-MUNIAPPA NAIDU Inactive �q N ® 1 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO517681 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO521105 EE0000000-HAZ MAT SJC OES Active Y N A' I D <br /> 2381 -UST FACILITY(BEFORE 1184)-obsolete PRO500994 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR1PR0517683 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0523946 EE0000060-JENNIFER RUIZ Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project spec,PHSlEHD hourly charges associated with this <br /> facility or activity will be billed to the party idenffied as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/&Standards and <br /> State and/or Federal laws. <br /> APPLICANT'S SIGNATURE: Date 1 6;D1 �� : A <br /> Program Records to be TRANSFERED: "$20.00= Amount Paid � Date ip / .29 /-06 l <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date 1 1 UN <br /> Payment Type L/ Check Number S , b Received 9 <br /> RENS: Date / ! Account out: date 1 2`T 1 DSS <br /> COMMENTS: }7 - AFY" <br /> 'q0� Cp <br /> --- FNr <br /> Ilphs-ehsq I-ntla ppslenvis ionslreports15021.rpt <br />