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Date run 10/20/2005 3:39:10P SAN JOW COUNTY ENVIRONMENTAL HEA EPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/20/2005 <br /> Record Selection Criteria: Facility ID FA0010456 <br /> Make changes/corrections in RED ink or penci <br /> INFORMATION CHANGE(date) O O <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008456 Case Number: H08136 New Owner ID <br /> Owner Name KINDER, STANLEY K <br /> Owner DBA SIERRA CHEMICAL CO(STKN) <br /> Owner Address 1010 INDUSTRIAL DR <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 775-358-0888 <br /> Mailing Address �O UoXJr©�-3a <br /> Care of /O <br /> FACILITY FILE INFORMATION T <br /> Facility ID <br /> r 1 <br /> Facility Name SIERRA CHEMICAL CO (STKN) �rPsk OI s�G 01 a� <br /> Location 1010 INDUSTRIAL DR <br /> STOCKTON, CA 95206 <br /> Phone 209-983-8298 <br /> Mailing Address 1010 INDUSTRIAL DR <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code APN:177-280-28 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017456 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SIERRA CHEMICAL CO (STKN) (Circe One) <br /> Account Balance as of 10/20/2005: $0.00 <br /> (Circle One) <br /> Transfer to Activedrachm <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner' Delete <br /> 2214-Ca1ARP FAC STATE SURCHARGE FEE PR0518994 EE0000988-KASEY FOLEY Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO518741 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO612744 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PR0514789 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0520328 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0510456 EE0000000-HAZ MAT SJC OES 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 spec,PHS/EHD hourly charges associated Win 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 /> 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 /> RENS: Date 7 / Account out: NI C-s' Date <br /> COMMENTS: <br /> \\ohs-ehsa I-nt\aoos\envisions\reports\5021.rot <br />