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Dale run 4411/2002 12:45:24PI SAN JOJW COUNTY ENVIRONMENTAL HE DEPARTMENT <br /> Report#5021Run by Pagel <br /> Facility Information as of 4/11/20 <br /> Record Selection Criteria: Facility ID FA0009975 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0007975 Case Number: H06100 New Owner ID <br /> Owner Name OLIVER&WINSTON <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 818-972-1200 <br /> Mailing Address 900-W-ALAMEDAAVE a 4j hoc <br /> --BURBAN-Ki CA 91-506- 901,1 um-c' I CA A 0502,-13?s <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009975 <br /> Facility Name WINSTON TIRE CO#183 <br /> Location 1648 E HAMMER LN <br /> STOCKTON, CA 95210 20 <br /> Phone 209-956-4223 <br /> Mailing Address ^ <br /> g09-W-A nn,�, ❑nye nvr A0 o <br /> BURBAidK,-CA-9+566 �u utM ce , A gb50L 1325 <br /> Care of LARRY FERONI <br /> Location Code APN:9428014 <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016975 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name WINSTON TIRE CO #183 (Circle One) <br /> Account Balance as of 4/11/2002: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PRO514117 EE0000008-LETITIA BRIGGS Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO512263 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509975 EE0o00000-HAZ MAT SJC OES 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 speck,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party idengfled as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes andlor 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: "$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date ! / Account out: Date <br /> o 2- <br /> COMMENTS: <br /> hLL,^, ''11 <br /> \\Phs-ehsq I-nt\apps\Envisions\Reports\5021.rpt <br />