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Runby : LAURIEB San—Joaquin County PHS/EHD • Report #5021 <br /> FACILITY INFORMATION as of 10/17/96 <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date): <br /> OWNERSHIP CHANGE (date): <br /> OWNER ID: 002970 New Owner to: 00 <br /> owner Name: MARLEY COOLING TOWER CO <br /> Owner DBA: MARLEY COOLING TOWER CO <br /> Owner Address: PO BOX 2912 74o �. 1.z9 SlrrPt <br /> MISSION, KA 66201 r7yzi'(and +aarK. Ks �loaj � <br /> Home Phone: 913-362-1818 <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 09 UNKNOWN <br /> Mai ling Address: PO BOX 2912 <br /> care of: DAVID BATES issiDn KS 6&aas-5 8 <br /> MISSION, KA 66201 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 004040 <br /> Facility Name: MARLEY COOLING TOWER CO <br /> Location: 150 N SINCLAIR AVE <br /> STOCKTON 95205 <br /> Phone: 913-362-1818 <br /> Mailing Address: <br /> Care of: DA D BATES <br /> MISr,10N, KA 66201 <br /> Location Code: 0 1 APN: - <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0003683 New Account ID: 000 <br /> Mail Invoices to: Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name: MARLEY COOLING TOWER CO (circle one) <br /> Account Balance as of 10/17/96 : $39 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br /> 2954 NPL/SEP SITE PROJECT PR009002 0997 KNOLL ACTIVE Y N A 1 D <br /> _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <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 <br /> BILLING PARTY on this form. 1 also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid Date_/ / <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid Date_/ / <br /> Payment Type Check # Recvd by <br /> REHS or COUNTER SUPV:4Z Date (0 /J_L/_J_b ACCT out: Date IC)/JL/� UNIT/File _/_/_ <br />