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Date run : 12/6/00 8:40:55AM SA*AQUIN COUNTY PUBLIC HEALTH SCE,$(j ,i �(r (�y��1J�I �� deport #: 0002 <br /> Run by TBRIGGS Facility Information as of 12/6/00 �j�fQt1� K,�'}{,�'lage #: 1 <br /> Record Selection Criteria: Facility ID FA0003749 <br /> Record lD <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> owner ID: OW0002786 New Owner ID <br /> owner Name: SAN JOAQUIN REGIONAL TRANSIT <br /> Owner DBA: <br /> Owner Address: 1533 E LINDSAY ST <br /> STOCKTON, CA 95205- <br /> Home Phone: 209-948-5566 <br /> Work/Bussness Phone: 209-948-5566 <br /> Mailing Address: 1533 E LINDSAY ST <br /> STOCKTON, CA 95205- <br /> Care of: S J REGIONAL TRANSIT DISTICT <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0003749 <br /> Facility Name: SJ REGIONAL TRANSIT <br /> Location: 1533 E LINDSAY ST <br /> STOCKTON, CA 95205 <br /> Phone: 209-948-5566 <br /> Mailing Address: 1533 E LINDSAY ST <br /> STOCKTON, CA 95205- <br /> Care of: SJ REGIONAL TRANSIT <br /> Location Code: 01 -STOCKTON A'PN; <br /> BOB District: 001 - GUTIERREZ, STEVE SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0003328 New Account ID:: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/ Facility/Account <br /> Account Name: SJ REGIONAL TRANSIT (Circle One) <br /> Account Balance as of 12/6/00: $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? Delete <br /> 2361 -NEW MULTI UST FACILITY PR0231158 EE0000008-BRIGGS Active 20 Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FE PR0506671 EE0000008-BRIGGS Active Y N A I D <br /> 2301 -UST STATE SURCHARGE PRO507692 EE0000008-BRIGGS Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511458 EE0000000-SJC DES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513682 EE0000008-BRIGGS 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 <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. I 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 Receipt Number Received by <br /> REHS: Date_/_/_ Account out: Date <br /> 1.0.0.89.00 <br />