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Run by : DIANE SAN JOA COUNTY PUBLIC HEALTH SERVICES <br /> Report #5021 FACILPY INFORMATION as of 08/03/94 <br /> ------------------------------------------------ ------------------------- <br /> Make changes/corrections in RED pen or pencil: <br /> i <br /> OWNER FILE INFORMATION Date of INFORMATION CHANGE: 81 4 <br /> Date of OWNERSHIP CHANGE: <br /> OWNER ID: 002996 New Owner ID: 00 <br /> Owner Name: DDRW (SHARPE) <br /> owner DBA: DDRW — SHARPES <br /> owner Address: PO BOX 960001 — BLDG S-4 <br /> STOCKTON, CA 95296-0250 <br /> Home Phone: 209-982-2093 <br /> work/Business Phone: 904-332-3318 <br /> Mailing Address: PO BOX 960001 — BLDG S-4 <br /> care of: ENVIRON PROTECT OFFICE <br /> STOCKTON, CA 95296-0250 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 004078 <br /> Facility Name: DDRW — SHARPES <br /> Location: 850 E ROTH RD <br /> LATHROP 95331 <br /> Phone: 209-982-2093 <br /> Mailing Address: 365 LENNON LN <br /> care of: MONTGOMERY ENG — J CHIEN <br /> WALNUT CREEK, CA 94598 <br /> Location Code: 99 APN: 198-020-01 <br /> BOS District: 99 SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0003738 New Account ID: 000 <br /> Mail Invoices to: Facility ,nI�N M• n <br /> Mail invoices to: Ower / Facility <br /> Account Name: ^nnr>• — .SHA.&PES' YY1 eomfX9 W^ Id..-Aaw <br /> Account Balance as of 08/03/94 : $ 195. 00 <br /> FILES LINKED: No WATER SYSTEM FILE linked <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ------------------- Employee------ Status --- LinkedDelete <br /> — new owner? ---- ---- <br /> 2954 NPL/SEP SITE PROJECT PR090141 0963 HINSON ACTIVE Y N A I D <br /> ------------------------------------------------ ------------------------------ <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date_/ /9_ <br /> ------------------------------------------------ <br /> Programs to be TRANSFERED x $20.00 = Amount Paid Date _/ /9_ <br /> Payment Type Check # Recvd by <br /> ______ �-L�------ ---------------------------/-------------------------g— <br /> REHS or COUNTER SUPV c�, Date7/9)/94' ACCT out: Date Q /�S/9' UNIT/File:_/_/ <br /> �� ` <br />