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Report#5021 <br /> run 10/11/2005 9:35:54A SAN JOA <br /> IN COUNTY ENVIRONMENTAL HEA 1 DEPARTMENT Pagel <br /> ,by Facility Information as of 10/1112005 <br /> tecord Selection Criteria: Facility ID FA0013994 <br /> Make changesicorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0003724 New Owner ID <br /> Owner Name BANK OF STOCKTON <br /> Owner DBA <br /> Owner Address PO BOX 1110 <br /> STOCKTON, CA 95201 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-941-1444 <br /> Mailing Address PO BOX 1110 <br /> STOCKTON, CA 95201 <br /> Care of BANK OF STOCKTON <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013994 <br /> Facility Name MONTE VISTA <br /> Location S STANISLAUS ST <br /> STOCKTON, CA 95202 <br /> Phone 209-929-1200 <br /> Mailing Address S STANISLAUS ST <br /> STOCKTON, CA 95202 <br /> Care of CHARLES HALDIN <br /> Location Code 01 -STOCKTON APN:149-200-10 <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0023681 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name CONDOR EARTH TECHNOLOGIES, INC (Circle One) <br /> Account Balance as of 1011112005: $0 <br /> (Circe One) <br /> Transfer to <br /> Active! ctv <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? elete <br /> 2950-ENVIRON ASSESS PR0518598 EE0000684-MICHAEL INFURNA A ve Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/ r project speoic.PHSIEHD 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 I I <br /> Program Records to be TRANSFEREO: *$20.00= Amount Paid Date 1 I <br /> Water System to be TRANS RED: *$372,00= Amount Paid Date 1 I <br /> Payment Type Check Number Rece v y <br /> REHS: Date /0 I 1� Account out: Date /12 I� <br /> COMMENTS: <br /> 11phs-ehsgl-nthappslenvisionslreports15021.rpt <br />