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Date run 9/26/2007 10:28:14AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/26/2007 <br /> Record Selection Criteria: Facility ID FA0018566 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002758 New Owner ID <br /> Owner Name PORT OF STOCKTON <br /> Owner DBA PORT OF STOCKTON <br /> Owner Address 2201 W WASHINGTON ST <br /> STOCKTON, CA 95203 <br /> Home Phone 209-946-0246 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 2089 <br /> STOCKTON, CA 952012089 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0018566 <br /> Facility Name YARA NO AMERICA/POS <br /> Location REID AVE <br /> STOCKTON, CA 95203 <br /> Phone <br /> Mailing Address PO BOX 2089 <br /> STOCKTON, CA 95201 <br /> Care of KOEHNEN, RITA <br /> Location Code 01 -STOCKTON APN:16203001 <br /> BOS District 003- MOW,VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0032876 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name YARA NO AMERICA/POS (Circle One) <br /> Account Balance as of 9126/2007: $-294.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New OwneR Delete <br /> 2950-ENVIRON ASSESS PR0527419 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 /> 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-ehsgl-nt\apps\envisions\reports\5021.rpt <br />