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Date run 5/16/01 1:42:34PM SAN*QUIN COUNTY PUBLIC HEALTH SEES Report #: 0002 <br /> Run byPage #: 1 <br /> Facility Information as of 5116/01 <br /> Record Selection Criteria: Facility ID FA0004081 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0002999 New Owner ID <br /> owner Name: FRIEDMAN, HARVEY BAG CO <br /> Owner DBA: GREAT WESTERN CHEMICAL <br /> owner Address: 801 E COMMERCE ST <br /> LOS ANGELES, CA 90012- <br /> Home Phone: 503-228-2600 <br /> work/Bussness Phone: 503-228-2600 <br /> Mailing Address: 801 E COMMERCE ST <br /> LOS ANGELES, CA 90012- <br /> care of: FRIEDMAN, HARVEY BAG CO <br /> FACILITY FILE INFORMATION <br /> Facility to: FA0004081 <br /> Facility Name: GREAT WESTERN CHEMICAL <br /> Location: S26 S CENTER ST <br /> STOCKTON, CA 95203 <br /> Phone: 503-228-2600 <br /> Mailing Address: 808 S W 15TH ST <br /> PORTLAND, OR 97205- <br /> care of: GREAT WESTERN CHEMICAL CO <br /> Location Code: 01 -STOCKTON APN, <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0003741 New Account ID:: <br /> Maillnvoicesto: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: GREAT WESTERN CHEMICAL (Circle one) <br /> Account Balance as of 5/16/01: $0.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactve <br /> PrograrntEiement and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2959-NON NPL/SEP HZ SITE PR0009061 EE0000684-INFURNA Active Y N A 0 <br /> D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific, <br /> PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all <br /> operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System t SFERED: '$150.00= Amount Paid Date <br /> Payment Typ Check Number Receipt Number-------- Received <br /> b/y" <br /> REHS: Date l (�O/ O Account out: Date 0/ <br /> _0L/—19( l 01 <br /> GOMMFN 16: <br /> 1.0.0.89.00 <br />