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Date run 11/13/2003 11:00:34/ SAN JO Ar)UIN COUNTY ENVIRONMENTAL HEA' "'H DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 11/13/_,3 <br /> Record Selection Criteria: Facility ID FA0014099 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011161 New Owner ID L1� <br /> Owner Name UNIFIRST CORP <br /> Owner DBA <br /> Owner Address 68 JONSPIN RD <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 <br /> Facility ID FA0014099 <br /> Facility Name UNIFIRST CORP <br /> Location 125 E FLORA RD <br /> STOCKTON, CA 95202 <br /> Phone 209-941-8364 <br /> Mailing Address PO BOX 877 <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 p <br /> Account ID AR0023836 O p 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 /> One) <br /> Transfer to Active/ actve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? elete <br /> 2950-ENVIRON ASSESS PR05 723 EE0000684-MICHAEL INFURNA Inve Y N UA I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersign 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 is 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 b RANSFERED: *$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: <br /> COMMENTS: <br /> ENVIRONMENTAL ENGINEERING AND 11220 35 1790 <br /> CONTRACTING, INC. 0350022007 <br /> PH. 714-667-2300 <br /> 501 PARKCENTER DR. DATE 11/13 03 — <br /> SANTA ANA, CA 99227005 <br /> PAYToTH <br /> ORDER OF <br /> E— r"`-i..►s�� -----_ — --.�1 a�� �� <br /> --- ------7 _DOLLARS <br /> UNION BANK OF CALIFORNYA <br /> ADAMS AVENUE #35 <br /> 'q99 ADAMS AVE.,HUNTINGTON BEACH,CA 92646 <br /> \\Phs-ehsql-nt\apps\Envisions\I 238 44861 <br /> FOR - <br /> 1 a annni rtc," n a i:nn -7 ann ?Ir 1 qrf <br />