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If <br /> Date run 7/9/2009 8:25:19AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/9/2009 <br /> Record Selection Criteria: Facility ID FA0018695 <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 OW0015362 New Owner ID <br /> Owner Name SURREYLTD <br /> Owner DBA ROBINHOOD PLAZA SHOPPING CENTE <br /> Owner Address �1.7F nA`3i G Arra 0oTF Dori <br /> STOCKTON, CA 95207 <br /> Home Phone 209-478-1791 <br /> Work/Business Phone Not Specified <br /> Mailing Address 5757 PACIFIC AVE STE 220 <br /> STOCKTON, CA 952075159 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0018695 <br /> Facility Name ROBINHOOD PLAZA/1-HR MARTINIZING <br /> Location 5766-PA&FIC AVE CEN' <br /> STOCKTON, CA 95207 <br /> Phone 209-478-1791 <br /> Mailing Address �/ ✓- <br /> STOCKTON, CA 952075159 <br /> Care of SURREY LTD <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002- RUHSTALLER, LARRY Fax <br /> APN 10227010 EMail : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name SURREY LTD <br /> Title <br /> Day Phone 209-478-1791 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0033154 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ROBIN HOOD PLAZA/1-HR MARTINIZING (Circle One) <br /> Account Balance as of 7/9/2009: $0.00 <br /> (Circle One) <br /> Transferlo Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWOCB SITE PR0527591 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/or project specific,PHS/EHD 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 applicable Ordinace Codes and/or Standards and <br /> Stale and/or Federal Laws. L� <br /> APPLICANT'S SIGNATURE: 2 r Ct \E 0 e Q C Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be T ERED: '$372.00^^= Amo t Paid Date / ! <br /> Payment Type ✓Check Number_ AD Received by Tllr� <br /> REHS: Date / Account out: 7f-T,, Date <br /> COMMENT : <br /> "Cl 77 <br /> 4f19��1 1 <br /> \\eh-env\envision\reports\5021.rpt <br />