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Date run 4/5/2007 1:44:50PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4/5/2007 <br /> Record Selection Criteria: Facility ID FA0004075 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002758 New Owner ID <br /> Owner Name PORT OF STOCKTON <br /> Owner DBA PORT OF STOCKTON <br /> Owner Address 2201 W WASHINGTON ST <br /> STOCKTON, CA 95203 <br /> Home Phone 209-946-0246 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 2089 <br /> STOCKTON, CA 952012089 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004075 <br /> Facility Name FORMER FALCON ENERGYIISC SITE <br /> Location #1 PORT RD 21 <br /> STOCKTON, CA 95203 <br /> Phone <br /> Mailing Address PO BOX 2089 <br /> STOCKTON, CA 95201 <br /> Care of RITA KOEHNEN <br /> Location Code 01 -STOCKTON APN. <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003735 New Account ID: <br /> Mail Invoices to FacilityMail Invoices to: Owner 1 Facility I Account <br />� <br /> Account Name FORMER FALCON ENERGYIISC SITE (Circle One) <br /> Account Balance as of 41512007: $-285.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Record ID Employee ID and Name Status New Owner? Delete <br /> ProgramlElement and Description P� <br /> 2950-ENVIRON ASSESS PROOD1237 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,andlor project specific.PHSIEHD hourly charges associated with this <br /> facility 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 applirable ordinate Codes and/or Standards and <br /> State andlor Federal Laws. <br /> APPLICANTS SIGNATURE: _ Date 1. 1 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date I 1 <br /> Payment Type <br /> Check Number Received by <br /> RENS: Date ! ! Account out: Date 1 1 <br /> COMMENTS: <br /> 11phs-ehsgl-ntlappsle nvisionslreports15021.rpt <br />