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Date run 8/47/2013 3:33:57PK SAN JOWIN COUNTY ENVIRONMENTAL HEAD DEPARTMENT Report#5021 <br /> Run by" Pagel <br /> Facility Information as of 8/27/2013 <br /> Record Selection Criteria: Facility 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 LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Home Phone 209478-9200 <br /> Work/Business Phone 209-478-9200 <br /> Mailing Ad3V� LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Care of wl;;�}I <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 �1 <br /> Mailing Address 'A�j "0-`"NITER ZS N�,�QM/}jbLv <br /> 7 Arc. CA 33 <br /> Care of IINlrnlnloanoG _R_TI=_^_r6aaTu L-INU554- MA-2S G—L�oI.00s4s1 <br /> Location Code 01 - STOCKTON <br /> Phone 1 <br /> BOIS District 002 - RUHSTALLER, LARRY Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 92.00 <br /> Night Phone 2eq-4Za-C g <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003648 New Account ID: <br /> Mail Invoices to --. A'Cd-!f• Mail Invoices to: Owner / Facility / Account <br /> Account Name LINCOLN CENTER (Circle One) <br /> Account Balance as of 8/27/2013: $0.00 <br /> (Circle One) <br /> Transfer to Activellnacive <br /> ProgrardElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB SITE PR0009029 &E`^^rT q§PJa S� Y I five Y t A I D <br /> r ����n <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHsEHD hourly charges assocI.a wiN Ihis facility <br /> or activity will be billed tome 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 State andor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date II <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date_II <br /> Water System to be TRANSFERED: Amount Paid Date / I <br /> Payment Type Check Number Received.b/y <br /> REHS: Date_/ / Account out: Date /�Z/ 1-3 <br /> COMMENTS: <br />