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Report 85021 <br /> Date run 8/20/2013, 4:27A3Pk SAN JOIN COUNTY ENVIRONMENTAL HEA*DEPARTMENT Pagel <br /> Run by Facility Information as of 8/20/2013 <br /> Record Selection Criteria: Facility 10 FA0013712 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID : 0 <br /> Owner ID O 0008721 se Number: H08572 New Owner ID <br /> Owner Name HE NA CHE CAL COMPANY MD <br /> Owner DBA <br /> Owner Address 255 HIL NG BLVD STE 300 <br /> COLLI VILLE, TN 38017 <br /> Home Phonal Not S Ified <br /> Work/Business Phon 901- 1- 050 <br /> Mailing Addres 60 5 PO LAR AVENUE#500 <br /> EMPHIS, N 38119 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS I FA0013 MY <br /> Facility Name AAtCACCO1mPAld°r <br /> Location 2245 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone 9-465-577 <br /> Mailing Address ! OX 66 S <br /> STO ON, CA 95201 <br /> Care of LUI ICES CA 3�— <br /> Location Code 0 - STOC TON <br /> Alt Phone <br /> BOS District Fax <br /> APN 16336017 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION n L n �l n� <br /> Contact Name�$At-A}GF� l— it'ry,, <br /> Title <br /> Day Phone 209-465-5777 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FIL ION <br /> Account I AR002295 New Account ID: <br /> Mail Invoices to aClllty Mail Invoices to: Owner / Facility / Account <br /> .rn noon. n (Circle One) <br /> Account Name nr -&GMPAAI Y <br /> Account Balance as of 8/20/2013: $0.00 (circle one) <br /> Trensferle Activellnaetve <br /> Pr lament and Description rd <br /> ID Employee ID and Name Status New owner? Delete <br /> 2950- NVIRON ASSESS PRO5181 EE0009903-DOUG WILSON Active Y N A I D <br /> LING and COMPLIANCE ACKNOWLEDGEMENT I,the und.niign or or agent of same,acknowledge that all site,al project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form I also candy that all operations will be performed in accordance with all applicable Ordinance Codes andfor Standards and Slate ifi ler <br /> Federal Law., <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 Receivy <br /> REHS: Date_/_/_ Account out: Date <br /> COMMENTS: <br />