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Date run, 4/29/2002 4:55:19PN SAN JOAN COUNTY ENVIRONMENTAL IALEPARTMENT Report#5021 <br /> Run by Facility Information as of 4/29/200 Pagel <br /> Record Selection Criteria: Facility ID FA0009781 <br /> Make changes/corrections in RED ink o <br /> INFORMATION CHANGE Ida AL <br /> OWNERSHIP CHANGE(date <br /> OWNER FILE INFORMATION <br /> Owner ID OW0007781 Case Number: H05408 New Owner ID : <br /> Owner Name HOUSE 2 HOME <br /> Owner DBA <br /> Owner Address 3345 MICHELSON DR <br /> IRVINE, CA 92612 <br /> Home Phone Not Specified <br /> Work/Business Phone 714-442-5754 <br /> Mailing Address 3345 MICHELSON DR <br /> IRVINE, CA 92175 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility I <br /> Facility Namee HOUSE HOUSE 2 2 HOME#1620 <br /> Location 1880 E HAMMER LN <br /> STOCKTON, CA 95210 20 0 <br /> Phone 209-477-8880 <br /> Mailing Address 3345 MICHELSON DR <br /> IRVINE, CA 92715 <br /> Care of HOUSE 2 HOME <br /> Location Code APN:094-280-12 <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016781 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name HOUSE 2 HOME#1620 (Circle One) <br /> Account Balance as of 4/29/2002: $417.50 <br /> (Circle One) <br /> Transfer to Active/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO514033 EE0000008-LETITIA BRIGGS Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512069 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509781 EE0000000-HAZ MAT SJC DES 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 identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes andtor 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 / --312 10.R— <br /> COMMENTS: d.R—COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />