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Dai e run �5/g/p006 8:21:18AM SAN JOIN COUNTY ENVIRONMENTAL HEAL .DEPARTMENT <br /> Run by Report#5021 <br /> Facility Information as of 6/9/2006 Pagel <br /> Record Selection Criteria: Facility ID FA0007013 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner I OW0005765 New Owner ID <br /> Owner Name MUNZER FAMILY TRUST <br /> Owner DBA MUNCOINC <br /> Owner Address 3450 E SPRING ST 218 <br /> LONG BEACH, CA 90806 <br /> Home Phone 562-283-1014 <br /> Work/Business Phone 562-283-1014 <br /> Mailing Address 3450 E SPRING ST STE 218 <br /> LONG BEACH, CA 90806 <br /> Care of DAPHNE MUNZER, TRUSTEE <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007013 <br /> Facility Name KOPPEL STOCKTON TERMINAL <br /> Location 2025 W HAZELTON AVE <br /> STOCKTON, CA 95206 <br /> Phone 562-283-1014 <br /> Mailing Address 3450 E SPRING ST STE 218 <br /> LONG BEACH, CA 90806 <br /> Care of DAPHNE MUNZER <br /> Location Code 01 -STOCKTON APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0010069 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account 3 <br /> Account Name MUN FAMILY TRUST (Circle One) J <br /> Account Balance as of 6/9/20 $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name status New Owner? Delete <br /> 2960-RWQCB SITE PR0505804 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,and/or project spec,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 /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TSFERED: '$372.00= Amount Paid Date <br /> Payment Type M Check Number Received by <br /> REHS: Date Account out: Date <br /> COMMENTS: <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />