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Date run 5/8/01 3:30:43PM N JOAQUIN COUNTY PUBLIC HEALTF 'RVICES Report #: 5023 <br /> Run by `A Page #: 1 <br /> Facility Information as of 5/8/01 <br /> Record Selection Criteria: Facility ID FA0005891 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0004692 New Owner ID <br /> Owner Name: REEDER, ROBERT <br /> Owner DBA: MID VALLEY TRAILER SALES <br /> Owner Address: 7115 CRYSTAL BLVD <br /> DIAMOND SPRINGS, CA 95619- <br /> Home Phone: 209-948-8305 <br /> Work/Bussness Phone: Not Specified <br /> Mailing Address: 7115 CRYSTAL BLVD <br /> DIAMOND SPRINGS, CA 95619- <br /> Care of: REEDER, ROBERT <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0005891 <br /> Facility Name: MID VALLEY TRAILER SALES <br /> Location: 2421 N WILSON WAYly / ( 1 `I V`i ( LS ON <br /> STOCKTON, CA 95205 —[ b <br /> Phone: 209-948-8305 <br /> Mailing Address: 44221C)N WILSON WAY <br /> S�3CKTON, CA 95205- <br /> Care of: MID VALLEY TRAILER SALES <br /> Location Code: 99- UNINCORPORATED AREA APN; <br /> Bos District: 002 - MARENCO, DARIO SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0006767 New Account ID:: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: MID VALLEY TRAILER SALES (Circle One) <br /> Account Balance as of 5/8/01: $0.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific, <br /> PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all <br /> operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I / <br /> Program Records to be TRANSFERED: *$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: *$150.00= Amount Paid Date <br /> Payment Type Check Number Receipt Number Received by <br /> RENS: / C. Date /F/ 1001 Account out: Date -o5 M <br /> 1.0.0.89.00 <br />