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,1012006 8:17:08AA SAN JOP ?N COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> - Page <br /> Facility Information as of 1/10/2006 <br /> ection Criteria Facility ID FA0016229 <br /> less 0 Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> WNER FILE INFORMATION <br /> Owner ID OW0013123 New Owner ID <br /> Owner Name ENSHER ALEXANDER AND BARSOOM <br /> Owner DBA BARSOOM PROPERTY UIC <br /> Owner Address 530 BERCUT DR STE D <br /> SACRAMENTO, CA 958140101 <br /> Home Phone 916-776-1843 <br /> Work/Business Phone Not Specified <br /> Mailing Address 530 BERCUT DR STE D <br /> SACRAMENTO, CA 958140101 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016229 a' <br /> Facility Name BARSOOM PROPERTY UIC <br /> Location 14200 BACON ISLAND RD <br /> STOCKTON, CA 95206 <br /> Phone 916-417-9113 <br /> Mailing Address 530 BERCUT DR STE D <br /> SACRAMENTO, CA 958140101 <br /> Care of ENSHER ALEXANDER AND BARSOOM <br /> Location Code 99 - UNINCORPORATED AREA APN'12920012 <br /> Bos District 003 - MOW, VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE. FILE INFORMATION <br /> Account ID AR0028366 New Account ID <br /> Mail Invoices to Account Mail Invoices to: Owner ! Facility ! Account <br /> Account Name BARSO RQPERTYUIC (DrdeOne) <br /> Account Balance as of 1/10/2008$0.00 j yam, <br /> (Circlep <br /> Transfer to Actielnactve ; <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? D <br /> 3030-UIC PROGRAM SITE PRO524157 EE0000684-MICHAEL INFURNA Ac Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT I.the undersigned owner,operator or agent of same,acknowledge that all site,and r project specific,PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. f also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State andfor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 <br /> Program Records to be TRANSFERED '$20-00= Amount Paid Date ! 1 <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date 1 ! <br /> Payment Type/ . �. Cheek Number Received by <br /> RENS: Date I/ IC I C(- Account out: � Date <br /> COMMENTS: / <br /> f <br /> I� <br /> llphs-ehsgl-ntlappslenvisions`reports15021.rpt <br />