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Date ryw: 2/14/01 8:35:37AMAQUIN COUNTY PUBLIC HEALTH SE ICES Report #: 0002 <br /> Runby : VHAYES <br /> Facility Information as of 2/14/01 `-� Page #: 1 <br /> Record Selection Criteria: <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner to: OW0007453 Case Num r: H04066 New Owner <br /> Owner Name: ROBERT M CROW, WM H CROW JR (/! <br /> Owner DBA- <br /> Owner Address. <br /> Home Phone: Not Specified <br /> Work/Bussness Phone: 209-931-0879 <br /> Mailing Address: X92-7.. +f S. <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility to: FA0009453 Detf(4-S'r0LXtUk, Pty• ( <br /> Facility Name: STOCKTON A KS U �� <br /> Location: 646 S CALIFORNIA ST <br /> STOCKTON, CA 952033705 /uailX r /1ZL� <br /> Phone: 209-466-9625 <br /> Mailing Address: 646 S CALIFORNIA ST <br /> STOCKTON, CA 95203-3705 <br /> Care of: R JR <br /> Location Code: 01 -STOCKTON APN; 149-086-02 <br /> SOS District: 001 -GUTIERREZ, STEVE SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0016453 New Account to:: <br /> Mall Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: STOCKTON ARMATURE & MOTOR WRKS (Circle One) <br /> Account Balance as of 2/14/01: $110.00 <br /> (Circle One <br /> UST(s) Transferto Active/Inacty <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner) Delete <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE F PR0509453 EEO000000-SJC OES Active Y N 1 <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO511741 EE0000000-SJC DES Active Y N <br /> 2220-SM HW GEN<5 TONSNR PR0513847 EE000D418-KITH Active Y N <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT.. I,the undersigned owner,operator or agent of same,acknowledge that all sit and/orpro'ed <br /> specific,PHSIEHD howdy charges associated with this facility or activity will be billed to the party ides: d as the BILLING PAR thisfornL <br /> also certify that all operations will be perfonned in accordance with all applicable Ordinace Codes and/or Standards and State atu la eral Laws <br /> APPLICANT'S SIGNATURE: <br /> Date <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 /> REHS: Date I / Account out: Date vZ / /6' <br /> / d <br /> 1 <br /> 1.0.0.89.00 �� Y <br />