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Date�un 6/16/2008 3:11:52PN SAN J01' `)UIN COUNTY-E-NVURONMENTAL HEA- •�%Fhii Report#5021 <br /> DEPARTMENT Pagel <br /> Run by .,� ,. .,�. Facility Information as of 9!1612 <br /> Record Selection Criteria: Facility ID FA0010597 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN!Fed Tax ID <br /> Owner ID OW0008597 Case Number: H08383 New Owner ID <br /> Owner Name POWER & EQUIP C! �= <br /> Owner DBA 6GfiFtt POWER_ & EQUIP_ Oq <br /> Owner Address 1041 S PERSHING A1rE: GLC <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 360-253-2346 ` <br /> Mailing Address 1041 S PERSHING AVE <br /> v <br /> STOCKTON,'CA 95206 V <br /> Care of 77 <br /> FACILITY FILE INFORMATION <br /> Facility 1D FA0010597 <br /> Facility Name ___ ..__ . _. _._ POWER& EQUIPS 1170W7� ` y. <br /> Location 1041 S PERSHING AVE <br /> STOCKTON, CA 95206 <br /> Phone 209-464-9600 <br /> Mailing Address 1041 S PERSHING AVE <br /> STOCKTON, CA 95206 <br /> Care of <br /> 1 <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 16330018 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> 1 Contact Name <br /> r Title SERVICE MANAGER <br /> Day Phone 209-464-9600 <br /> Night Phone 209-610-6145 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017597 New Account ID: <br /> Mail Invoices to Facility e/9 S16 -Mail Invoices to: Owner I Facility 1 Account <br /> Account Name EtetrVVESTE17MPOWER& EQUIP (Circle One) <br /> Account Balance as of 911612008: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PR0514381 EE0008317-RAYMOND VON FLUE Active Y N I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0512885 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520427 EE0000000-HAZ MAT SJC OES Active Y N , V I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARiPR0510597 EE0000000-HAZ MAT SJC OES Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: [,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,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 accordancewith all applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / 1 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date I ! <br /> Payment Type Check Number Receivedff:Date <br /> REHS: Date ! ! Account out: 1 I <br /> COMMENTS: <br /> 11phs-ehsgl-nAappslenvisionslreports15021.rpt <br /> t <br />