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Date mn008 4:53:18P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/31/2008 <br /> Record Selection Criteria: Facility ID FA0018695 <br /> Make changes/corrections in RED ink or pencil. <br /> F INCHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0015362 New Owner ID <br /> Owner Name SURREY LTD <br /> Owner DBA ROBINHOOD PLAZA SHOPPING CENTE <br /> Owner Address 57 '7 hLtfi.c AtlgF Si�e _jxt:3 <br /> STOCKTON, CA 95207- 5/Sy <br /> Home Phone 209-478-1791 <br /> Work/Business Phone Not Specified <br /> Mailing Address <br /> STOCKTON, CA 95207 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0018695 <br /> Facility Name ROBINHOOD PLAZA/1-HR MARTINIZING <br /> Location 5756 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone <br /> Mailing Address r ^^ BIR CTE SIP <br /> STOCKTON, CA 95207 <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 <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0033154 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ROBINHOOD PLAZA/1-HR MARTINIZING (Circle One) <br /> Account Balance as of 10/31/2008: $262.50 <br /> (Circle One) <br /> Transferto Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB SITE PRO527591 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 houry charges associated with this <br /> facility or activity will be billed to the parry 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 /> State and/or Federal Laws. ,, (�'C.� ,t \ p <br /> APPLICANT'S SIGNATURE: 0�n6,40— –6.,XtDate 10 /�/O o <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date_/_/ <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date / / <br /> Payment Type Check Number Received by <br /> REHS: Date_/ / Account out: Date // J .3 /-)e <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt • <br />