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i <br /> Date run 3/1i/2008 10:11:41AI Report 45021 <br /> SAN J(SUIN COUNTY ENVIRONMENTAL HEA�i DEPARTMENT <br /> Run by 1273 Pagel <br /> Facility Information as of 3/1 112005 <br /> Record Selection Criteria: Facility ID FA0009294 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CH N? <br /> OWNERSHIP CHA E(da <br /> OWNER FILE INFORMATION <br /> Owner ID OW0007294 Case Number: H02912 New Owner : 0/,grnapj� �u2 <br /> k Fpl <br /> Owner Name ALPINE PACKING CO <br /> Owner DBA ALPINE PACKING CO INC <br /> Owner Address 9900 LOWER SACRAMENTO RD <br /> STOCKTON, CA 952691358 <br /> Home Phone Not Specified <br /> WorkBusiness Phone 209-477-2691 <br /> Mailing Address PO BOX 691358 'Rb <br /> �BLP�F_J� SAL)'64M1tE.\i>b 'RD <br /> STOCKTON, CA 962691358— <br /> Care of qJa lO . <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009294 <br /> Facility Name ALPINE PACKING CO INC <br /> Location 9900 LOWER SACRAMENTO RD <br /> STOCKTON, CA 95210 <br /> Phone 209-477-2691 <br /> Mailing Address PO BOX 691358 <br /> STOCKTON, CA-95269t358- <br /> Care of 45 a ( o <br /> Location Cade APN:084-080-01 <br /> BOS District SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016294 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ALPINE PACKING CO INC (Circle One) <br /> Account Balance as of 3/11/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/lnactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2214-CaIARP FAC STATE SURCHARGE FEE PRO518931 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO513755 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0511582 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PR0514554 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0519523 EEOOOOOOO-HAZ MAT SJC DES Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PRO500484 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPRO509294 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2836-AST FAC>/=100 M+1 GAL CUMULATIVE PR0527165 EE0004636-GARRETT BACKUS 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 wfth this <br /> facility or activity unit be billetl to the party identified as the OWNER on this form. I also cenny that all operations will be performetl in accordance With all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS 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 b <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> r <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />