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DiAe ru;,,..11/13/1\1�'1;UO:34/ SAN JO' ^UIN COUNTY ENVIRONMENTAL HEAT—11 DEPARTMENT Report#5021 <br /> Ru:,by \��C�,%\ ,i\\�\\\_j; Page <br /> Facility Information as of 11/13/2--1 <br /> (� nteria: ility ID FA0014099 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> `��\I �NM� OWNERSHIP CHANGE(date) <br /> OWNk E *VV RMATION I <br /> \\" Owner ID OW0011161 New Owner ID V <br /> Owner Name UNIFIRST CORP <br /> Owner DBA ^n <br /> Owner Address 68 JONSPIN RD �v <br /> WILMINGTON, MA 018871086 <br /> Home Phone 209-941-8364 <br /> Work/Business Phone Not Specified <br /> Mailing Address 68 JONSPIN RD <br /> WILMINGTON, MA 018871086 <br /> Care of UNIFIRST CORPORATION <br /> FACILITY FILE INFORMATION �I- _ u <br /> Facility ID F 4 R <br /> Facility Name UNIF ST CORP vo <br /> Location 125 E FLORA RD <br /> STOCKTON, CA 95202 <br /> Phone 209-941-8364 n t-t <br /> Mailing Address PO BOX 877 1 {�� 5-cz2. is <br /> STOCKTON, CA 95201 <br /> Care of PETER BERNADICOU <br /> Location Code 01 -STOCKTON APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID A�� New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name UNIFIRST CORP (Circle One) <br /> Account Balance as of 11/13/2003: $0.00 <br /> Transfer to A=.lete Program/Element and Description Record ID Employee ID and Name StatusNew Owner? <br /> 2950-ENVIRON ASSESS PR0518723 EE0000684-MICHAEL INFURNA In ve Y N I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/ r 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 b RANSFERED: '$155.00= Amount Paid D <br /> Payment Type Check Number iv <br /> REHS: Date Account out: ate <br /> COMMENTS: <br /> \\Phs-ehsq l-n t\apps\Envisions\Reports\5021.rpt <br />