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Date run 9/23/2004 10:11:52AI SAN X UIN COUNTY ENVIRONMENTAL HEf d DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/23/2004 <br /> Record Selection Criteria: Facility ID FA0001783 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011375 New Owner ID <br /> Owner Name HOLMAN INVESTORS LLC <br /> Owner DBA HOLMAN INVESTORS LLC <br /> Owner Address 3200 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-956-9303 <br /> Mailing Address 3200 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0001783 <br /> Facility Name HOLMAN INVESTORS LLC <br /> Location 3200 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Phone 209-956-9303 <br /> Mailing Address 3200 E EIGHT MILE RD <br /> STOCKTON, CA 95212 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN: <br /> BOS District 002 - MARENCO, DARIO SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0001783 NewAccount ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name HOLMAN INVESTORS LLC (Circle One) <br /> Account Balance as of 9/23/2004: $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 /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO511641 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2226-CalARP PROGRAM PR0514570 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PR0220097 EE0003580-MICHELLE LE Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0521246 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84) PR0503813 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PR0515780 EE0003580-MICHELLE LE Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0507283 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0461084 EE0000102-STEVE MINDT Inactive 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 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 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 TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / 1 Account out: Date <br /> COMMENTS: <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />