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Date run y7/2006 11:33:33AM SAN JOA^UIN COUNTY ENVIRONMENTAL HEAL-'A DEPARTMENT Report asozl <br /> Run by Pagel <br /> �.. Facility Information as of 2/7/200b" <br /> 'Record selection Callers: Facility ID FA0015074 <br /> Make changeslcorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0012058 New Owner ID <br /> Owner Name MASSEY, CARL <br /> Owner DBA MASSEY HYDRAULIC <br /> Owner Address <br /> Home Phone 209-464-4487 <br /> Work/Business Phone Not Specified <br /> Mailing Address 4831 E FREMONT ST <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015074 <br /> Facility Name MASSEY HYDRAULIC <br /> Location 4831 E FREMONT ST <br /> STOCKTON, CA 95205 <br /> Phone 209-464-4487 <br /> Mailing Address 4831 E FREMONT ST <br /> STOCKTON, CA 95205 <br /> Care of CARL MASSEY <br /> Location Code APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025812 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MASSEY HYDRAULIC (Circle One) <br /> Account Balance as of 2/7/2006: $1,072.00 <br /> (Circe One) <br /> Transfer to AclivellnacNe <br /> Record ID Employee Program/Element and Description P oYee 10 and Name Status New Owri Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO522114 EE0008373-jet N-JA61ES9N 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 identfied as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes a1M/or Standards and <br /> Stale and/or Federal Laws, <br /> APPLICANTS 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 Type Check Number Received by <br /> REHS: Date_/ /_ Account out: Date <br /> COMMENTS. <br /> al � � o� 10 <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt -- <br />