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Date run 9/3/2013 3:58:33PM SAN JOSIN COUNTY ENVIRONMENTAL HEA1*DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/3/2013 <br /> Record Selection Criteria: Facility ID FA0013712 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0004439 New Owner ID <br /> Owner Name RAYMOND INVESTMENT CORPORATION <br /> Owner DBA RAYMOND INVESTMENT CORPORATION <br /> Owner Address PO BOX 567 <br /> STOCKTON, CA 95201 <br /> Home Phone 209-466-8604 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 567 <br /> STOCKTON, CA 95201 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility lD/CERS ID FA0013712 <br /> Facility Name RAYMOND INVESTMENT CORPORATION <br /> Location 2245 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-466-8604 <br /> Mailing Address 600 S HWY 59 <br /> MERCED, CA 95340 <br /> Care of CLARK BIRD (CFO) <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16336017 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CLARK BIRD <br /> Title CFO <br /> Day Phone 209-466-8604 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022954 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name RAYMOND INVESTMENT CORPORATION (Circle One) <br /> Account Balance as of 9/3/2013: $-875.00 <br /> (Circle One) <br /> ProgranvElement and DescriptionRecord ID Employee ID and Name Status Transfer to ActiveAnactve <br /> New Omen Delete <br /> 2950-ENVIRON ASSESS PR0518127 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project speck,PHSIEHD hourly charges associated with this facility <br /> or activity,will be billed to the party identified as the OWNER on this form l also certify that all operations will be performed in accordance with all applicable Ordinance Codes ani Standard,and State andiar <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$25.00= Amount Paid Date_/_/ <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date_/ / Account out: Date <br /> COMMENTS: <br />