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Date ran 11/14/2007 8:14:17A SAN JOIN COUNTY ENVIRONMENTAL HEAP DEPARTMENT Report#5021 <br /> Run by 4006 Pagel <br /> Facility Information as of 11/14/2 <br /> Record Selection Criteria: Facility ID FA0018453 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008158 New Owner ID <br /> Owner Name BIER, WAYNE <br /> Owner DBA TRIUMPHS ONLY <br /> Owner Address 1881 E MARKET ST <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-939-1020 <br /> Mailing Address 1881 E MARKET ST <br /> STOCKTON, CA 95205 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018453 <br /> Facility Name BIER PROPERTY <br /> Location 1523 E MAIN ST <br /> STOCKTON, CA 95205 <br /> Phone <br /> Mailing Address 1881 E MARKET ST <br /> STOCKTON, CA 95205 <br /> Care of BIER WAYNE <br /> Location Code 01 -STOCKTON APN:15304011-14-15 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032602 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name BIER PROPERTY (Circle One) <br /> Account Balance as of 11/14/2007: $-95.00 <br /> (Circle One) <br /> Transfer to Activednactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Ovmer? Delete <br /> 2950-ENVIRON ASSESS PRO527250 EE0006219-LORI DUNCAN 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 Orainaca Codes and/or Standards and <br /> State andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: $372.00= Amount Paid E.29 q- Date <br /> Payment Type Check Number 2-1-5 24 Received by 40f— <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> /I�4S13 PAYMENT <br /> RECFI\IFD <br /> NOV 13 2007 <br /> SAN JOAQUIN COUNT! <br /> ENVIRONMENTAL <br /> OEALTH DEPARTMENT <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />