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Date run 2/25/2002 10:57:17AI SAN JO)r COUNTY ENVIRONMENTAL HEAL. DEPARTMENT Report#5021 <br /> Run by • Pagel <br /> Facility Information as of 2/25/2 <br /> Record Selection Criteria: Facility ID FA0012833 <br /> Make changes/corrections in RED ink or pen I. <br /> INFORMATION CHANGE(date) Z Z 0 <br /> OWNERSHIP CHANGE(date) Z U2 <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002672 New Owner lD <br /> Owner Name () n V4rSDo C10 Crp fru Umk/�'_ <br /> Owner DBA <br /> Owner Address 1113 SHAW RD <br /> STOCKTON, CA 952154081 <br /> Home Phone Not Specified <br /> Work/BusinessPhone 206-466-963-) <br /> Mailing Address 1113 SHAW RDQ•0. 8 ox Z D l D <br /> STOCKTON, CA 952154081 SRN SoSR I C4 �S 159 <br /> Care of BOBCAT CENTRAL INCye- IA^WW'lS <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012833 <br /> Facility Name �n, VQ( � 5wryplrlj` �rVtca- <br /> Location 1113 SHAW RD f <br /> STOCKTON, CA 952154081 <br /> Phone <br /> Mailing Address 1113 SHAW RD <br /> STOCKTON, CA 952154081 <br /> Care of B )BCCAT CENTRAI INC \) �', VZ SS 1, 51JV 1ls"-j <br /> Location Code 01 -STOCKTON APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021565 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ATC ASSOCIATES INC (Circle One) <br /> Account Balance as of 2/25/2002: $-69.60 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 2950-ENVIRON ASSESS PR0516823 EE0006219-LORI DUNCAN Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror 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 ancilor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />