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Date,nu. a 9/4/2008 3:12:38PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> gun by Facility Information as of 9/4/2008 Pagel <br /> Record Selection Criteria: Facility ID FA0018695 <br /> Make changes/corrections in RED ink or pencil. <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 SURREY LTD <br /> Owner DBA ROBINHOOD PLAZA SHOPPING CENTE <br /> Owner Address 1024 W ROBINHOOD DR STE 1 <br /> STOCKTON, CA 95207 <br /> Home Phone 209-478-1791 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1024 W ROBINHOOD DR STE #1 <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 1024 W ROBINHOOD DR STE#1 <br /> STOCKTON, CA 95207 <br /> Care of SURREY LTD <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOIS 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 New Account 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 9/4/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omar? 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,acknuvdedge(hat all site,and/or project spec,PHS/EHD hourly 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 /> Stale and/or Federal Laws. <br /> 17-'11I2 <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid 3\ S - Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number 2 L -2— <br /> S Received by <br /> REHS: Date / / Account out: Date / / <br /> COMMENTS: <br /> RECEIVED <br /> SEP - 4 2008 <br /> SAN JOAQUIN COUNNTAL TY <br /> • <br /> ENVIRONMENT,DEPAR <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt TMENT <br />