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I <br /> Date mn 11/18/2013 2:19:44P SAN JOE IN COUNTY ENVIRONMENTAL [-TEAL' DEPARTMENT Report #5021 <br /> Run by Paget <br /> Facility Information as of 11 /18/2013 <br /> Record Selection Criteria: Facility ID FA0020827 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID <br /> Owner ID OW0008373 Case Number: H07909 New Owner ID <br /> Owner Name SAN JOAQUIN CO <br /> Owner DBA <br /> Owner Address 44 N SAN JOAQUIN ST STE 590 <br /> STOCKTON , CA 95202 <br /> Home Phone 209-468-9625 <br /> Work/Business Phone 209-468-3363 <br /> Mailing Address 44 N SAN JOAQUIN ST STE 590 <br /> STOCKTON , CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID / CERS ID FA0020827 <br /> Facility Name RECORDS CENTER <br /> Location 630 N CALIFORNIA ST <br /> STOCKTON , CA 952022119 <br /> Phone 209-468-3220 <br /> Mailing Address 1722 E SCOTTS AVE <br /> STOCKTON , CA 952056240 <br /> Care of <br /> Location Code 01 - STOCKTON It Phone <br /> BOS District 001 - VILLAPUDUA Fax <br /> APN 13916510 EMail : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 209-468-3220 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0037402 New Account ID: : j <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CONDOR EARTH TECHNOLOGIES INC (Circle One) <br /> Account Balance as of 11 /18/2013: $-183.00 <br /> (Circle One) <br /> Transfer to Active/Inectve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950 - ENVIRON ASSESS PR0536244 EE0001699 - JOHNNY YOAKUM Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andfor project specific, PHSIEHD hourly charges associated with this facility <br /> r 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 Ordinance Codes and/or Standards and State and'or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: * $25.00 = Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid. Date if <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> III <br /> k <br />