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Date run 4/24/2003 8:29:36AN SANJCib IN COUNTY ENVIRONMENTAL HE DEPARTMENT Report#5021 <br /> Run by _ Paget <br /> Facility Information as of 4/24/20 3 <br /> Record Selection Criteria: Facility ID FA0013383 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0010518 New Owner ID <br /> Owner Name BENNET,TIM <br /> Owner DBA SAN JOAQUIN VALLEY ASSOCIATES <br /> Owner Address 2333 SAN RAMON VALLEY BLVD <br /> SAN RAMON, CA 94903 <br /> Home Phone 925-820-6677 <br /> Work/Business Phone Not Specified <br /> Mailing Address 411 YOKUT AVE#107 <br /> STOCKTON, CA 95207 <br /> Care of CROSSWINDS OF CALIF (SFD DEV) <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013383 <br /> Facility Name BRIDGEPORT TRAILS DEVELOPMENT <br /> Location 1904 CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone <br /> Mailing Address 411 YOKUT AVE#107 <br /> STOCKTON, CA 95207 <br /> Care of CROSSWINDS OF CALIF <br /> Location Code APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022283 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name GLENN SPRINGS HOLDINGS INC (Circle One) <br /> occount Balance as of 4/24/2003: $0.00 <br /> (Circle One) <br /> Transfer to Ac*e/Inactve <br /> 3rogram/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0517372 EE0000684-MICHAEL INFURNA Inactive Y N A I D <br /> TILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSlEHD hourly charges associated with this <br /> acillty or 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 Ordinace Codes and/or Standards and <br /> sate and/or Federal Laws. <br /> \PPLICANT'S SIGNATURE: Date <br /> )rogram Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Nater System to be TRANSFERED: _*$155.00= Amount Paid Date <br /> 'ayment Type Check Number Received by <br /> tEHS: Date / / Account out: Date ! / <br /> :OMMENTS: <br /> Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />