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Date mn 5/3/2005 9:12:17AM SAN JOA' "TN COUNTY ENVIRONMENTAL HEALT-`>7EPARTMENT Report#5021 <br /> Run by _�.�—"— Paget <br /> ... Facility In ormation as of 5/3/2005' - „ , <br /> Record Selection Criteria: Facility ID FA0003541 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002647 New Owner ID <br /> Owner Name BLINCOE, u ° Q1 1A� :or ^oE, 8-JIB <br /> Owner DBA BJJ COMPANY INC <br /> Owner Address 2431 E MARIPOSA RD <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> work/Business Phone 209-941-8361 <br /> Mailing Address PO BOX 30010 <br /> STOCKTON, CA 95213 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0003541 <br /> Facility Name BJJ COMPANY 4NCE LL e- <br /> Location 2431 E MARIPOSA RD <br /> STOCKTON, CA 95205 <br /> Phone 209-941-8361 <br /> Mailing Address PO BOX 30010 <br /> STOCKTON, CA 95213 <br /> Care of <br /> Location Code 01 -STOCKTON APN 17130003 <br /> Bos District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003120 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name BJJ COMPANY INC (Circle One) <br /> Account Balance as of 5/3/2005: $0.00 <br /> (Circe One) <br /> Transfer to gpivellnacNe <br /> Record ID Employee ID and Name Status New Owners Delete <br /> PrograMElemenl and Description <br /> 2220-SM HW GEN<5 TONS/YR PRO513705 EE0008844-DINA CRAW Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511503 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO519468 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2361 -UST FACILITY PR0231818 EE0008844-DINA CRAW Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAIRPRO507346 EE0000008-LETITIA•BRIGGS Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523530 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 4630-NTNC WATER SYSTEM WAG461334 EE0000811 -MIKE HUGGINS 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 spec,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 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: -*$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs�hsgl-nt\apps\envisions\reports\5021.rpt <br />