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Date run : 3/26/01 11:30:110AM SAP 7AQUIN COUNTY PUBLIC HEALTH SEf :ES Report #: 0002 <br /> Run by : AYOUNGBLOOD J. Facility Information as of 3/26/01 "W <br /> Page #: 1 <br /> Record Selection Criteria: FacilityID FA0010813 <br /> Record to <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0008813 Case Number: H08801 New Owner ID <br /> Owner Name: GURJIT BASSI <br /> Owner DBA <br /> Owner Address <br /> Home Phone: Not Specified <br /> Work/Bussness Phone: 209-599-5855 <br /> Mailing Address: PO BOX 3 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0010813 <br /> Facility Name: G&S TRUCK WASH RIPON <br /> Location: 816 FRONTAGE RD <br /> RIPON, CA 95366 20 <br /> Phone: 209-599-5855 <br /> Mailing Address: PO BOX 3 <br /> RIPON, CA 95366- <br /> Care of: GURJIT BASSI <br /> Location Code: APN; 261-020-10 <br /> BOS District: 005 - CABRAL, ROBERT SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0017813 New Account ID:: <br /> Mail Invoices to: Account Mail Invoices to: Owner/ Facility/Account <br /> Account Name: G&S TRUCK WASH RIPON (Circle One) <br /> Account Balance as of 3/26/01: $0.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? %2e <br /> 2220-SM HW GEN<5 TONS/YR PR0514423 EE0007289-YOUNGBLOOD Active Y N A UD <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FI PR0510813 EE0000000-SJC DES Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZAT ON PR0513101 EE00o0000-SJC DES Active Y N A I D <br /> 7L ,'o.-u.ac&4;-e w/065 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or <br /> project specific,PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this <br /> form. 1 also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal <br /> Laws. <br /> APPLICANTS SIGNATURE: Date / I <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Type Check Number Re//—L c��ei1'pt Number Received by_rr <br /> / <br /> REHS: l�Date�/ a/yAccount <br /> out: — -3 Date L az O -Jo-1 . - - <br /> �ZiC,�'1� <br /> 1.0.0.89.00 <br />