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FRun <br /> emn 3/26/2010 3:42:40PA SAN JCf's"'�UIN COUNTY ENVIRONMENTAL HEAL.": DEPARTMENT <br /> byReport#5021 <br /> Facility Information as of 312612011r, Pagel <br /> Record Selection Criteria: Facility ID FA0003531 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002638 New Owner ID <br /> Owner Name PARK, OSUK <br /> Owner DBA BEST CLEANERS <br /> Owner Address 715 CHENIN BLANC DR <br /> LODI, CA 95240 <br /> Home Phone 209-333-2338 <br /> Work/Business Phone 209-369-2865 <br /> Mailing Address 715 CHENIN BLANC DR <br /> LODI, CA 95240 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003531 <br /> Facility Name BEST CLEANERS <br /> Location 541 N HUTCHINS ST <br /> LODI, CA 95240 <br /> Phone 209-369-2865 <br /> Mailing Address 541 N HUTCHINS ST <br /> LODI, CA 95240 <br /> Care of OSUK PARK <br /> Location Code 02 - LODI Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 03725001 EMail. <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name OSUK PARK <br /> Title <br /> Day Phone 209-369-2865 <br /> Night Phone 209-333-2338 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003109 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name BEST CLEANERS CirdeOne) <br /> Account Balance as of 3/26/2010: $0.00 <br /> (Circle One) <br /> Transfer to Activellnacwe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0522211 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0232385 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0533751 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project spec,PHS/EHD hourly charges associated with this <br /> facility or activity vall 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 /> Stale and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Dale <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 /> REHS: Date / / Account out: Date <br /> COMMENTS <br /> \\eh-env\envision\reports\5021.rpt <br />