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Date run 7/26/2004 9:54:04AN SAN JV'kQUIN COUNTY ENVIRONMENTAL HEH DEPARTMENT Report#5021 <br /> Run by Page <br /> Facility Information as of 7/26/2 <br /> Record Selection Criteria: Facility ID FA0013593 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0010711 New Owner ID <br /> Owner Name HENRY FOPPIANO <br /> Owner DBA MORADA PRODUCE <br /> Owner Address 500 N JACK TONE RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-931-2137 <br /> Mailing Address PO BOX 8038 <br /> STOCKTON, CA 95208 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013593 <br /> Facility Name MORADA PRODUCE WATER SYSTEM <br /> Location 500 N JACK TONE RD <br /> STOCKTON, CA 95215 <br /> Phone 209-546-0426 <br /> Mailing Address PO BOX 8038 <br /> STOCKTON, CA 95208 <br /> Care of HENRY J FOPPIANO <br /> Location Code APN: <br /> BOS District SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022724 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name HENRY FOPPIANO (Circle One) <br /> Account Balance as of 7/26/2004: $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 /> 2214-CalARP FAC STATE SURCHARGE FEE PR0522225 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2221 -USED OIL ONLY-<5 TONS/YR PR0522596 EE0008373-JOHN JACKSON Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520560 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0515514 EE0000753-WILLIE NG Active 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 / / Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsq I-nt\apps\Envisions\Reports\5021.rpt <br />