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Date run 11/8/2006 4:29:10Pn SAN JOA N COUNTY ENVIRONMENTAL HEALIWEPARTM ENT Report#5021 <br /> Pagel <br /> Run by Facility Information as of 11/8/2006 <br /> Record Selection Criteria: Facility ID FA0013712 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008721 Case Number: H08572 New Owner ID <br /> owner Name HELENA CHEMICAL COMPANY <br /> Owner DBA <br /> Owner Address 255 SCHILLING BLVD STE 300 <br /> COLLIERSVILLE,TN 38017 <br /> Home Phone Not Specified <br /> Work/BusinessPhone 901-761-0050 <br /> Mailing Address 6075 POPULAR AVENUE#500 <br /> MEMPHIS, TN 38119 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013712 <br /> Facility Name HELENA CHEMICAL COMPANY <br /> Location 2245 W CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-465-5777 <br /> Mailing Address PO BOX 1066 <br /> STOCKTON, CA 95201 <br /> Care of LUIS SALAICES <br /> Location Code 01 -STOCKTON APN 16336017 <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022954 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name HELENA CHEMICAL COMPANY (Circle one) <br /> Account Balance as of 11/8/2006: $0.00 <br /> (Circle Ona) <br /> Transfer to Acfive/Inaclve <br /> Record ID Employee ID and Name Status New Owner? Delete <br /> Program/Element and Description <br /> 2950-ENVIRON ASSESS PRO518127 EE0009903-DOUG WILSON Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility 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 /> State andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: -*$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsq l-nt\apps\envisions\reports\5021.rpt <br />