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Date run 5/14/2003 8:17:39AN SAN JUIN COUNTY ENVIRONMENTAL HE.9H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/14/2003 <br /> Record Selection Criteria: Faclity ID FA0014531 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011558 New Owner iD <br /> Owner Name MURDOCH, ROBERT K <br /> Owner DBA CITY OF STOCKTON <br /> Owner Address 2500 NAVY DR <br /> STOCKTON, CA 95206 <br /> Home Phone 209-937-8734 <br /> Work/Business Phone Not Specified <br /> Mailing Address 2500 NAVY DR <br /> STOCKTON, CA 95206 <br /> Care of ROBERT K MURDOCH <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014531 <br /> Facility Name <br /> Location +56@J4pgy-DTZ— _ <br /> STOCKTON, CA 95206 D vo <br /> Phone 209-937-8734 �Jp i(/ctky /atuyr <br /> Mailing Address 2500 NAVY DR 0 <br /> STOCKTON, CA 95206 <br /> Care of ROBERT K MURDOCH <br /> Location Code APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024714 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: ner Facility / Account <br /> Account Name J (circle one) <br /> Account Balance as of 5/14/2003: $-267.00 <br /> (Circle One) <br /> Transfer to <br /> Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 2950-ENVIRON ASSESS PR0521409 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor 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 and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid <br /> Water System to be TRANSFERED: '$155.00= Amount Paida <br /> Payment Type Check Number '`/ by <br /> RENS: Date /�/ D3 Account <br /> COMMENTS: <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt low <br />