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Dale run 9/11/2013 1:08:35Pn SAN JOIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report x5021 <br /> Pagel <br /> Run by Facility Information as of 9/11/2013 <br /> Record Selection Criteria: Facility ID FA0007271 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002955 New Owner ID <br /> Owner Name LINCOLN PROPERTIES LTD <br /> Owner DBA <br /> Owner Address 374 LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Home Phone 209-478-9200 <br /> Work/Business Phone Not Specified <br /> Mailing Address 374 LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0007271 <br /> Facility Name LINCOLN CNTR ENV REMEDIATION TRUST <br /> Location PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone 510-237-1782 <br /> Mailing Address 137 PARK PLACE <br /> RICHMOND, CA 94801 <br /> Care of MARKADAMS <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MARK ADAMS <br /> Title <br /> Day Phone 510-237-1782 <br /> Night Phone 510-237-1782 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0010736 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> (Circle One) <br /> Account Name ARCADIS <br /> Account Balance as of 9/11/2013: $-1,062.50 (Circle One) <br /> Transfer to Activemactve <br /> Program/Element and Description <br /> Record ID Employee ID and Name Status New Omer? Delete <br /> 2960-RWQCB SITE PR0506203 EE0000684-MICHAEL INFURNA 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"project specdic,PHSIEHD hourly charges associated with thisfacilily <br /> 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 Ordinance Codes andor Standards and Stale and« <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> RENS: Date_/_/_ Account out: Date <br /> COMMENTS: <br />