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q <br /> Run by : STAFF San Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 10/24/97 <br /> ------------------------------------------------------------------------------- <br /> 'J Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: 006202 New owner ID: 0 0 <br /> Owner Name: STOCKTON jj SAVINGS BANK <br /> Owner DBA: , <br /> Owner Address: 501 W 'WEBER AVE <br /> STOCKTON; CA 95201 <br /> Home Phone: 209-54777610 <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: 501 W ;WEBER AVE <br /> Care of: TOM BUGARIN <br /> STOCKTON,'' CA 95201 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007499 <br /> Facility Name: STOCKTON :.SAVINGS BANK <br /> Location: 201 N MAIN ST <br /> MANTECA 95336 <br /> Phone: 209-547-7610 <br /> Mailing Address: 501 W WEBER AVE <br /> Care of: TOM BUGARIN <br /> STOCKTON,, CA 95201 <br /> Location Code: AEN: <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0011724 New Account ID: 000 <br /> Mail Invoices to: Account Mail Invoices to:. Owner / Facility / Account <br /> Account Name: GUARANTY •'FEDERAL BANK (Circle one) <br /> Account Balance as of 10/2 4/9 7 : $0 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> ------------------------------------------------------------------------------- <br /> f a <br /> 2950 ENVIRON ASSESS PRS06554 0684 INFURNA INACTIVE Y N A I D <br /> -------------------------------------------------------------------------------- <br /> i <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> i <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> ---------------------=--------------------------------------------------------- <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid Date <br /> Water System to be TRANSFERED: _ x $150.00 = Amount Paid Date <br /> Payment Type Check # Recvd by <br /> REHS or COUNTER SUPV: Date / / ACCT out: Date-/-/- UNIT/File: / <br /> t <br /> v <br />