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Run by : BARB SAN JOAQUIN PUBLIC HEALTH SERVICES <br /> Report #5021 FACILITY INFORMATION as of 05/19/94 <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Make changes/corrections in this column: <br /> OWNER FILE INFORMATION Date of OWNERSHIP CHANGE: <br /> OWNER ID: 004723 New Owner ID: 00 <br /> Owner Name: FIORE, FRANK <br /> Owner DBA: <br /> owner Address: 129 E CENTER ST <br /> MANTECA, CA 95336 <br /> Home Phone: <br /> Work/Business Phone: <br /> Mailing Address: 129 E CENTER ST <br /> Care of: FIORE, FRANK <br /> MANTECA, CA 95336 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 005929 <br /> Facility Name: FIORE, FRANK <br /> Location: 129 E CENTER ST <br /> MANTECA 95336 <br /> Phone: <br /> Mailing Address: 129 E CENTER ST <br /> care of: FIORE, FRANK <br /> MANTECA, CA 95336 <br /> Location Code: 0 4 APN: <br /> BOS District: 04 SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0006869 New Account ID: 000 <br /> Mail Invoices to: Account Mail Invoices to: Owner / Facility <br /> Account Name: WHF ENVIRONMENTAL <br /> Account Balance as of 05/19/94 : $ 0 . 00 <br /> FILES LINKED: No WATER SYSTEM FILE Linked Y / N <br /> Record UST(s) Transfer to Inactivate/ <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _�_ _ _ _ _ _ _ _ _ _ _ _ _ _0 <br /> 2950 ENVIRON ASSESS PR503658 0451 SASSON ACTIVE Y / N / D <br /> _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1, 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—/—/9- <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Programs to be TRANSFERED: x 820.00 = Amount Paid Date —/—/9— <br /> Payment <br /> / /9_Payment Type Check k Recvd by <br /> - - - - - - - - - - - - - - -- - - - - - - - - - - - -)-/- - - - - - - - - - - - - r - - - - - - - - - - - l/ - - - - - - - - - - - - <br /> REHS or COUNTER SUPV: S � Date S / / ! /9- ACCT out: Date/-/9 'T UNIT/File:_/ /9_ <br />