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Date run 9/12/2013 9:29:15Ah SAN JOIN COUNTY ENVIRONMENTAL HEA10DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/12/2013 <br /> Record Selection CriteriaFacility ID FA0004017 <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 FA0004017 <br /> Facility Name LINCOLN CENTER <br /> Location PACIFIC/BENJAMIN HOLT AVE <br /> STOCKTON, CA 95207 <br /> Phone 209-478-9200 <br /> Mailing Address 374 LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002- RLIHSTALLER, LARRY Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name LINDSAY MARSH <br /> Title GEOLOGIST (ERM) <br /> Day Phone 916-924-9378 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003648 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ERM (Circle One) <br /> Account Balance as of 9/12/2013: $-1,375.00 <br /> (Circle One) <br /> Transfer to Adivennactve <br /> Program(Elemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB SITE PR0009029 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party idemied 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 state andfor <br /> Federal taws <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 /> REHS: Date_/_/ Account out: Date <br /> COMMENTS: <br />