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Date run : 1/8/01 8:44:57AM SAIOAQUIN COUNTY PUBLIC HEALTH SEES Report u: 0002 <br /> Run by LBROWN Facility Information as of 118/01 - Page : i <br /> Record Selection Criteria: Facility ID FA0012156 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE (date) <br /> Owner ID: OW0009429 New Owner ID <br /> Owner Name: CITY OF STOCKTON <br /> Owner DBA: HOUSING & REDEVELOPMENT DEPT <br /> Owner Address; 305 N EL DORADO ST <br /> STOCKTON, CA 95202-1997 <br /> Home Phone: 209-937-8840 <br /> Work/Bussness Phone: Not Specified <br /> Mailing Address: 305 N EL DORADO ST <br /> STOCKTON, CA 95202-1997 <br /> Care of: HOUSING & REDEVELOPMENT DEPT <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0012156 <br /> Facility Name: NORTH SHORE PARCEL <br /> Location: FREMONT ST <br /> STOCKTON. CA 95202 <br /> Phone <br /> Mailing Address: 305 N EL DORADO ST <br /> STOCKTON, CA 95202-1997 <br /> Care of: HOUSING & REDEVELOPMENT DEPT <br /> Location Code: APN: <br /> BOS District. SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0019501 New Account ID:: <br /> Mail Invoices to: Account Mail Invoices to: Owner/ Facility/Account <br /> Account Name: STOCKTON REDEVELOPMENT AGENCY (Circle One) <br /> Account Balance as of 1/8/01: $-117.00 <br /> (Circle One <br /> UST(s) Transfer to Active/Inacty <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0615453 EE0009488-WONG Active Y N I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that aU site,and/orproject <br /> specific,PHS/EHD hourly charges associated with this facility or activity will be billed to the part tdenti//r''ed as the B/LLINGPARTYon thisform I <br /> also certify that all operations will be performed in accordance with all applicable Ordinace Codes andlor Standards and State and/or Federal Laws <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$0.00= Amount PaidDate <br /> Water System to be TR SFERED: •$150.00= Amount Paid Date <br /> Payment Type ✓ J . —Check Number 3 ba-LP D Receipt Number Received by ' <br /> REHS: Date / / Account out: _6 Date <br /> W4- b'Vi • <br /> 1.0.0.89.00 <br />