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)) <br /> Run by : STAFF S ��� ''Joaquin County PHS/EHD ` Report #5021 <br /> FACILITY INFORMATION as of 09/29/98 <br /> ------------------------------------------------------------------------------- <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: 002669 New Owner ID: 0 0 <br /> Owner Name: WASHINGTON MUTUAL <br /> Owner DBA: <br /> Owner Address: 17877 VON KARMAN 3RD FLOOR <br /> IRVINE, CA 92714 <br /> Home Phone: 949-833-4665 <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 03 PARTNERSHIP <br /> Mailing Address: 17877 VON KARMAN 3RD FLOOR <br /> Care of: WASHINGTON MUTUAL <br /> IRVINE, CA 92714 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 004093 <br /> Facility Name: AMER SAVINGS/LIGHTHOUSE SCHOOL <br /> Location: 222 N EL DORADO ST <br /> STOCKTON 95202 <br /> Phone: 209-546-2434 <br /> Mailing Address: 17877 VON KARMAN 3RD FLOOR <br /> Care of: WASHINGTON MUTUAL <br /> IRVINE, CA 92714 <br /> Location Code: O 1 APN: 139-100-19-2 <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0003 753 New Account ID: 000 <br /> Mail Invoices to: Account Mail Invoices to: <br /> Owner / Facility / Account <br /> Account Name: WASHINGTON MUTUAL <br /> (Circle one) I <br /> Account Balance as of 09/29/98 $0 . 00 <br /> (Circle one) <br /> i <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> ------------------------------------------------------------------------------- <br /> 2960 RWQCB CLEAN UP SITE PR009146 0684 INFURNA ACTIVE Y N A I D <br /> i <br /> ------------------------------------------------------------------------------- <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be <br /> performed in accordance with all applicable SAN 30AQL7IN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> ------------------------------------------------------------------------------- <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid Date / / <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid Date <br /> Payment Type Check # Recvd by <br /> ------------------------------------------------------------------------------- <br /> REHS or COUNTER SUPV: Date-/-/ ACCT out: Date-/-/. UNIT/File: <br /> I <br />