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Date run : 2/14/01 8:31:02AM SA AQUIN COUNTY PUBLIC HEALTH S ES Report u: 0002 <br /> Run by VHAYES Facility Information as of 2/14/01 Page iF: 1 <br /> Record Selection Criteria: Facility ID FA0007013 / 1/ <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0005765 New Owner ID <br /> Owner Name: RUDOLPH, JAMES/DAPHNE A MUNZER &441LUe 7P-USF- <br /> Owner <br /> Owner DBA: KOPPEL STOCKTON TERMINAL ALA O'n <br /> Owner Address: 401 E OCEAN BLVD STE 501 if �1 <br /> LONG BEACH, CA 90802- <br /> Home Phone: 310-491-0127 — D <br /> Work/BussnessPhone: 310-491-0914 12k16 —/0/1/ <br /> Mailing Address: 401 E OCEAN BLVD STE 501 <br /> LONG BEACH, CA 90802- fis .46Z)-YC- <br /> Care <br /> DCare of: DAN MUNZER l ti0 uny✓l 'TrastC.e- <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: 310-491-0127 <br /> Mailing Address: 401 E OCEAN BLVD STE 501 Dyl <br /> LONG BEACH, CA 90802- <br /> Care of: DAN MUNZER ✓1/.0 rF G <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 <br /> Account Name: RUDOLPH, JAMES/DAPHNE A MUNZER (Circle One) <br /> Account Balance as of 2/14/01: $0.00 <br /> (Circle One <br /> UST(s) Transfer to Active/Inacly <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PR0505804 EE0000684-INFURNA Active Y N I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of saw,acknowledge that all site,and/orpro/'ea <br /> specific,PHS/EHD hourly charges associated with this facility or activity will be billed to the party idem i red as the BILLING PABTYon thisform I <br /> also certify that all operations will be performed in accordance with all applicable Ordinace Codes an or Standards and Slate and/or Federal Laws <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: •$150.00= Amount Paid Date / / <br /> Payment Type Check Number Receipt Number Received by <br /> REHS: Date / / Account out: Date -U �/2j— <br /> 1.0.0.89.00 <br />