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Date run 2/'22/2002 11:11:36AI SANJO <br /> Run by AN <br /> COUNTY ENVIRONMENTAL HEA.LEpgRTMENT Reportp5ozl <br /> Facility Information as of 2/22/200 Pagel <br /> Record Selection CrRena: Ia-Ay ID FA0012304 <br /> L <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0009539 New Owner ID <br /> Owner Name JIMENEZ, ALFONSO <br /> Owner DBA <br /> Owner Address 2382 E NINTH ST <br /> STOCKTON, CA 95206 <br /> Home Phone 209-959-0846 <br /> Work/Business Phone 209-464-9302 <br /> Mailing Address 2382 E NINTH ST <br /> STOCKTON, CA 95206 <br /> Care of ALFONSOJIMENEZ <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012304 yv � <br /> Facility Name ELDORADO AUTO <br /> Location 2070 S EL DORADO ST <br /> STOCKTON, CA 95206 <br /> Phone 209-464-9302 <br /> Mailing Address 2070 S EL DORADO <br /> STOCKTON, CA 95206 <br /> Care of ALFONSOJIMENEZ <br /> Location Code 01 - STOCKTON APN: <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0020046 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ELDORADO AUTO (Circle One) <br /> Account Balance as of 2/22/2002: $217.50 <br /> Transfer to (Circle One) <br /> Re <br /> Program/Elementantl Descri tion New Owner? Acbi lnactve <br /> P cord ID Employee ID and Name Status NDelete <br /> 2220-SM HW GEN<5 TONS/YR PR0515714 EE0000451 -STEVE SASSON Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0517552 EE0000451-STEVE SASSON Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPRO515762 EE0000451 -STEVE SASSON Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project speck,PHS/EHD 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 <br /> Program Records to be TRANSFERED: •$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Type Check Number Receive r <br /> REHS: Date /_/ Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />