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Date run 9/14/2004 8:23:47Ak SAN JO,UIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/14/2 4 <br /> Record Selection Criteria: Facility ID FA0012758 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0006345 New Owner ID <br /> Owner Name FOX RIVER PAPER CO <br /> Owner DBA FOX RIVER PAPER CO <br /> Owner Address 942 S STOCKTON AVE <br /> RIPON, CA 95366 <br /> Home Phone Not Specified <br /> Work/Business Phone 920-733-7341 <br /> Mailing Address 942 S STOCKTON AVE <br /> RIPON, CA 95366 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012758 <br /> Facility Name FOX RIVER PAPER CO <br /> Location 942 S STOCKTON AVE <br /> RIPON, CA 95366 <br /> Phone 209-599-0275 <br /> Mailing Address 942 S STOCKTON AVE <br /> RIPON, CA 95366 <br /> Care of PAT MICKLESON <br /> Location Code APN: <br /> BOS District 005- ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021327 NewAccount ID: <br /> Mail Invoices to: Owner / Facility / Account <br /> Mail Invoices to Facility <br /> Account Name FOX RIVER PAPER CO (Circle One) <br /> Account Balance as of 9/14/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> New Owner? Delete <br /> 7Element and Description Record ID Employee ID and Name Status <br /> #,0-RW \ B CLEAN UP SITE(SLIC) PR0516727 EE0006219-LORI DUNCAN Active Y N A I D <br /> 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 Ordinate 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: *$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date iV 1��1 Account out: _?��— Date ` /�� <br /> COMMENTS: / T <br /> 6L <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />