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Date ren 7/6/2010 11:51:01AM SAN JOAN COUNTY ENVIRONMENTAL HEALTEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 7/6/2010 Pagel <br /> Record Selection Criteria: Facility ID FA0013413 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW 0001176 New Owner ID <br /> Owner Name CITY OF STOCKTON <br /> Owner DBA <br /> Owner Address 425 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-937-8377 <br /> Mailing Address 425 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Care of CITY OF STOCKTON <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013413 <br /> Facility Name VACANT LOT FRMR UNOCAL OPER UNIT <br /> Location 504 WEBER AVE <br /> STOCKTON, CA 95202 <br /> Phone 209-937-7547 <br /> Mailing Address 425 N EL DORADO ST RM 317 <br /> STOCKTON, CA 95202 <br /> Care of CITY OF STOCKTON <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 13737003 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CITY OF STOCKTON <br /> Title <br /> Day Phone 209-937-7547 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022380 NewAcceunt ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility I Account <br /> Account Name TREADWELL& ROLLO INC (CirdeOne) <br /> Account Balance as of 7/6/2010: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inadve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB SITE PRO517413 EE0003611 -FRANK GIRARDI 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 forth. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State andlor 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 /> \\eh-env\envision\reports\5021.rpt <br />