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Ranby ': SANDY SaJoaquin County PHS/EHD • Report #5021 <br /> FACILITY INFORMATION as of 07/28/99 <br /> ----- -- - -- -- ------------------------------------------------------------------- <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: 003565 NewAo^�r!ILD: 0I0 , <br /> Owner Name: M T S Of ea <br /> owner DBA: INDEPENDENT TRUCKING <br /> Owner Address: 1145 W CHARTER WAY hA4 <br /> f. 421 <br /> STOCKTON, CA 95206 (,j,�11r41W. CA q60144- <br /> Home <br /> r 01Home Phone: 209-943-1287 6150- 0,11 <br /> Soo Sec# / Tax ID#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: PO BOX 6336 <br /> care of: ERIC HORTON <br /> STOCKTON, CA 95206 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 004672 <br /> Facility Name: INDEPENDENT TRUCKING <br /> Location: 1145 W CHARTER WY <br /> STOCKTON 95206 <br /> Phone: 209-466-5192 <br /> Mailing Address: 1145 W CHARTER WY <br /> Care of: <br /> STOCKTON, CA 95206 <br /> Location Code: 0 1 APN: <br /> SOS District: 001 SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0005073 New Account ID: 000 <br /> Mail Invoices to: Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name: INDEPENDENT TRUCKING (Circle one) <br /> Account Balance as of 07/28/99 : $0 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> e/E uescripcion ID Employee Status Linked new owner? Delete <br /> ------------------------------------------------------------------------------- <br /> 2960 RWQCB CLEAN UP SITE PR009298 0684 INFURNA ACTIVE Y N A I 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/END hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I 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 /> - <br /> Payment Type Check # Recvd by <br /> __ _ <br /> RENS or COUNTER SUPV: Date_/_/_ ACCT out: Date/ / UNIT/File:_/_/ <br />