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Run by : SANDY San Joaquin County PHS/EHD Report #5021 FACILITY INFORMATION as of 05/29/98 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Make changes/corrections in RED pen or pencil: OWNER FILE INFORMATION INFORMATION CHANGE (date): OWNERSHIP CHANGE (date): OWNER ID: 006291 New Owner ID: 00 owner Name: BABCOCK, JAMES owner DBA: SERVICE LAUNDRY owner Address: 348 S LOWER SACRAMENTO RD LODI, CA 95742 PAGLIERO & ASSOCIATES A PROFE55IONAL CORPORATION Home Phone: 209-369-5634 Soc Sec# / Tax ID#: ownership Type: 02 INDIVIDUAL JOHN A. MCFADDEN Mailing Address: 348 S LOWER SACRAMENTO RD ATTORNEY AT LAW care of: JAMES BABCOCK LODI, CA 95742 5701 A MARCONI AVENUE (916)461-7100 FACILITY FILE INFORMATION CARMICHAEL. CALIFORNIA 95608 FAX (916)481-7101 FACILITY ID: 007620 Facility Name: SERVICE LAUNDRY Location: 712 S LODI AVE LODI 95240 Phone: Mailing Address: 348 S LOWER SACRAMENTO RD PAM /�[ �] b care of: JAMES BABCOCK i Cl LODI, CA 95742 Location Code: 0 2 APN: BOS District: SIC Code: ACCOUNTS RECEIVABLE FILE INFORMATION ACCOUNT ID: 0012416 New Account ID: 000 Mail Invoices to: Owner Mail Invoices to: Owner / Facility / Account Account Name: BABCOCK, JAMES (Circle one) Account Balance as of 05/29/98 : $62 .40 (Circle one) Record UST(s) Transfer to Activate / Inactivate P/E Description ID Employee Status Linked new owner? Delete - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - 2960 RWQCB CLEAN UP SITE PR506773 0756 OZ ACTIVE Y N A I D - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or project specific PNS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PR Records to be TRANSFERED: x $20.00 = Amount Paid Date Water System to be TRANSFERED: x $150.00 = Amount Paid Date—/—/ Payment Type Check # R cvd by RENS or COUNTER SUPV Date / / ACCT out. Date / / UNIT/File: Y C