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Date run 10/24/2007 10:40:48/ SAN JWIJIN COUNTY ENVIRONMENTAL HEH DEPARTMENT Report#5021 <br /> Run by f -W. Pagel <br /> Facility Infor .'3tion as of 10/241 7 <br /> Record Selection Criteria: Facility ID FA0017455 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0014296 Aew Ownir ID <br /> Owner Name PAPA'S MACHINERY INC <br /> Owner DBA PAPE MACHINERY INC <br /> Owner Address 8621 N EL DORADO ST <br /> STOCKTON, CA 95210 <br /> Home Phone Not Specified <br /> Work/Business Phone 541-341-3344 <br /> Mailing Address PO BOX 407 <br /> EUGENE, OR 97440 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017455 <br /> Facility Name PAPE MACHINERY INC <br /> Location 8621 N EL DORADO ST <br /> STOCKTON, CA 95210 <br /> Phone 209-834-4774 <br /> Mailing Address PO BOX 407 <br /> EUGENE, OR 97440 <br /> Care of <br /> Location Code APN: <br /> BOS District SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030337 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name PAPA'S MACHINERY INC (Circle One) <br /> Account Balance as of 10/24/2007: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2244-PACT TRANSFER RECORD-OES PR0525640 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 specific,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 Ordinace 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: `$372.00= Amount Paid Date <br /> Payment pe Check Number Rec i ed by <br /> REHS: Date /L— Ac count out: _ Date <br /> COMMENTS: � /� ] <br /> 1 <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />