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Date run 10/28/2005 1:44:07F SAN JOIN COUNTY ENVIRONMENTAL HEADEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/28/20 <br /> Record Selection Criteria: Facility ID FA0012794 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) _ <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0009968 New Owner ID <br /> Owner Name STOCKTON PORT DISTRICT <br /> Owner DBA <br /> Owner Address 2201 W WASHINGTON ST <br /> STOCKTON, CA 95203 <br /> Home Phone 209-946-0246 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 2089 <br /> STOCKTON, CA 952012089 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012794 <br /> Facility Name STOCKTON PORT DISTRICT <br /> Location W HOUSE RD <br /> STOCKTON, CA 95203 <br /> Phone 209-946-0246 <br /> Mailing Address PO BOX 2089 <br /> STOCKTON, CA 952012089 <br /> Care of <br /> Location Code APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021420 New Account ID: _ <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ENVIRONMENTAL RISK SERVICES CORP (Circle One) <br /> Account Balance as of 10/28/2005: $372.00 <br /> (Circle One) <br /> Transfer to Active/Inaclve <br /> New Owner? Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2960-RWQCB SITE DEL-£-r' r) 6773 EE0000942-MARGARET LAGORIO Inactive Y N A I D <br /> 2965-WATER QUALITY SITE PROJECT PR0523853 E0000942-MARGARET LAGORIO Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigne owner, perator 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 so 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= �XAunt <br /> nt Paid Date <br /> Water System to be TRANSFERED: '$372.00= Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Ac unt out: Date <br /> COMMENTS: <br /> 1 <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />