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Date run 3/14/2008 11:57:19AI SAN JOAC* COUNTY ENVIRONMENTAL HEALTSVPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/14/2008 <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 <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 /> ailing Address 1024 W ROBINHOOD DR STE#1 <br /> 1",11"1,��� '> STOCKTON, CA 95207 <br /> 1dCare of SURREY LTD <br /> Q a^ cation Code 01 -STOCKTON APN 10227010 <br /> 80S District 002- RUHSTALLER, LARRY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> AccountlD AR0033154 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ROBIN HOOD PLAZA/1-HR MARTIN]ZING (Circle One) <br /> Account Balance as of 3/14/2008: $-294.00 <br /> L� 3 j <br /> ` h J D r Cr \ ` (Circe One) <br /> Transfer to AGive/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS 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,andlor 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 /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <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 <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisionsVeports\5021.rpt ` <br />