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Date mn 5/23/2007 12:10:10PI SAN JOAc &�N COUNTY ENVIRONMENTAL HEAL'I?M�EPARTMENT Report ff5021 <br /> Paget <br /> Run by Facility Information as of 5/23/2007 <br /> Record Selection Criteria: Facility ID FA0016241 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> Flu OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION ��■ <br /> Owner ID OW0001176 New Owner ID <br /> Owner Name CITY OF STOCKTON <br /> Owner DBA <br /> Owner Address 425 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-937-8377 <br /> Mailing Address 425 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Care of CITY OF STOCKTON <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016241 l �0.� <br /> Facility Name cJ���'� <br /> Location 2500 NAVY DR <br /> STOCKTON, CA 95206 <br /> Phone 209-931=874f)-- q,3 -2 - '8 -7 b 3 <br /> Mailing Address 2500 NAVY DRf' <br /> STOCKTON, CA 95206 are <br /> Care of <br /> Location Code 01 -STOCKTON APN:16333003 r 1I 14lr fiE3 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0028404 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / acility Account <br /> Account Name ) <br /> Account Balance as of 5/23/2007: $-182.00 <br /> (Circle One) <br /> Transfer to Active/IrecNe <br /> PrograrNElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2965-WATER QUALITY SITE PROJECT PR0524190 EE0009488-JEFFf2EYtM0NG-- Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same acRnov+t�dge �al11site,and project specific,PHSIEHD hourly charges associated with this <br /> facility or acthrity 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 Ordinace Codes andfor Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid 'o S•(SD Date 5 /23 IPI— <br /> Water <br /> P`LWater System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type ✓ Check Number g Re ved by Cf <br /> REHS: Date / / Account out: Date S / 3 <br /> COMMENTS: <br /> RFc�V ND <br /> SAN AY 2 3 TO p7 <br /> N JS JOAQUIN�b <br /> EALTH pEp�E�A(� <br /> �fNT <br /> \\ohs-ehsal-nt\apps\envisions\reportsk502l.rpt <br />