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Data run 4/19/2005 9:43:04Ah SAN JC UIN COUNTY ENVIRONMENTAL HEI 4 DEPARTMENT Report#5021 <br /> Run by ` <br /> v Facility Information as of 4/19/2005 Paget <br /> Record Selection Criteria: Facility ID FA00155$5 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0012533 New Owner ID <br /> Owner Name PENNINGTON, SUNG HI <br /> Owner DBA <br /> Owner Address 9135 N HILDRETH RD <br /> STOCKTON, CA 95212 <br /> Home Phone 209-931-9082 <br /> Work/Business Phone Not Specified <br /> Mailing Address 9135 N HILDRETH LN <br /> STOCKTON, CA 95212 <br /> Care of PENNINGTON, SUNG HI <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0015585 <br /> Facility Name PENNINGTON, SUNG HI <br /> Location 10285 N HILDRETH RD <br /> STOCKTON, CA 95212 <br /> Phone <br /> Mailing Address 9135 N HILDRETH LN <br /> STOCKTON, CA 95212 <br /> Care of PENNINGTON, SUNG HI <br /> Location Code 01 - STOCKTON APN:08653026 <br /> Bos District 004- SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026892 New Account.I D: <br /> Mail lnvoicesto Account Mail Invoices to: Owner / Facility / Account <br /> Account Name PENNINGTON, SUNG HI (circle One) <br /> Account Balance as of 4/19/2005: $55.80' ?,E 40 <br /> (Circle one) <br /> Transfer to ActiveMactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omen Delete <br /> 1322-SUBSTANDARD HOUSING-POSTED PR0523089 EE0000369-ALAN BIEDERMANN Active Y N A I D <br /> 030- IC <br /> 3PROGRAM SITE PR0523204✓ EE0000684-MICHAEL INFURNA Ac e Y N A10 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same.acknowledge that all site,and/or 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 Ordinate 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 a TRANSFERED: "$155.00= Amount Paid Date <br /> Payment Type Check Number Receiv y <br /> REHS: Date Account out: Date / / <br /> COMMENTS: <br /> - <br /> � <br /> \1phs-ehsq)-ntlapps\envisionslreports15021.rpt LM/ <br />