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Date run 2119/2004 4:15:07Pn SAN JOWN COUNTY ENVIRONMENTAL HE DEPARTMENT Report#5021 <br /> Run by r I Paget <br /> Facility Information as of 2/19/20 <br /> Record Selection Criteria: Facility ID FA0014919 <br /> Make changes/corrections in RED ink or pencil. <br /> SeINFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION ��, <br /> Owner ID OW0011926 It; Owner ID <br /> Owner Name JACOBS, FELIX `1 <br /> Owner DBA JAUREGUI BODY SHOP �uU <br /> Owner Address 43 CONNIE CT <br /> BAY POINT, CA 945651576 <br /> Home Phone 925-864-9094 <br /> Work/Business Phone 209-470-0864 <br /> Mailing Address 43 CONNIE CT <br /> BAY POINT, CA 945651576 <br /> Care of FELIX JACOBS <br /> FACILITY FILE INFORMATION / <br /> FacilityI 'FA <br /> Facility N JAUREGUREG UI BODY SHOP = OA <br /> Location 819 E FREMONT ST <br /> STOCKTON, CA 95202 <br /> Phone 209-470-0864 <br /> Mailing Address 819 E FREMONT ST ^� ND MAL L- eJ= rl+ ccs " <br /> STOCKTON, CA 95202 <br /> Care of FELIX JACOBS <br /> Location Code APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025455 New Acc�wt-t6� <br /> Mail Invoices to F I y Mail Invoices to: Owner // Facility / Account <br /> Account Name JAUREGUI BODY SHOP (Circle One) <br /> Account Balance as of 2/19/2004: $224.00 <br /> (Circle One) <br /> Transfer to <br /> Activerinactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO521940 EE0008373-JOHN JACKSON Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0516005 EE0009999-SITE UNASSIGNED Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPRO516006 EE0009999-SITE UNASSIGNED Inactive 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: IA tV T`t,`�`-r Date 1 / / l Uq <br /> Program Records to be TRANSFERED: -*$20.00=- Amount Paid Date <br /> Water System to be TRANSFERED: *$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: 7fL Date y l l D <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />