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Date run 8/25/2008 3:14:50PN SAN JOAN J COUNTY ENVIRONMENTAL HEALT ZPARTMENT Report#5021 <br /> Run by 5290 Pagel <br /> Facility Information as of 8/25/2008 <br /> Record Selection Criteria: Facility ID FA0014223 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011277 New Owner ID <br /> Owner Name HESS-DUBOISE AKA LA SALLE EST <br /> Owner DBA HESS-DUBOISE AKA LA SALLE EST <br /> Owner Address 7455 E PASARO DR <br /> SCOTTSDALE, AZ 85262 <br /> Home Phone 480-595-6224 <br /> Work/Business Phone Not Specified <br /> Mailing Address 7455 E PARSARO DR <br /> SCOTTSDALE, AZ 85262 ` <br /> Care of PETER J WALLACE JR, TRUSTEE <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014223 <br /> Facility Name HESS DUBOIS <br /> Location 348 W HARDING WAY <br /> STOCKTON, CA 95203 <br /> Phone 408-595-6224 <br /> Mailing Address 7455 E PASARO DR <br /> SCOTTSDALE, AZ 85262 <br /> Care of PETER J. WALLACE JR, TRUSTEE <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name PETER J WALLACE JR <br /> Title TRUSTEE <br /> Day Phone 480-595-6224 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024108 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name HESS DUBOIS (Circle One) <br /> Account Balance as of 8/25/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Statu New Owner? ete <br /> 2960-RWQCB SITE PRO518922 EE0000684-MICHAEL INFURNA A Ive Y N I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,and/ project specific,PHS/EHD hourly charges associa ith 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 and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRA FERED: *$20.00= Amount Paid Date <br /> Water System to be NS ERED: *$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date $ / 2—(,/ 0'i <br /> COMMENTS: 17 <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />