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Date run 4/30/2003 3:30:35PR SAN JOE` -TIN COUNTY.ENVLRONMENTAL HEAL " ' DEPARTMENT Report #5021 <br />Run by <br />Facility Information as of 4/30/2003 Pagel f , <br />Record Selection Criteria: Facility ID FA00G1698 J L <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0001329 <br />Owner Name <br />ZECH, WILLIAM <br />Owner DBA <br />VICTORIA ISLAND FARMS <br />Owner Address <br />16021 W HWY 4 <br />STOCKTON, CA 95206 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />310-659-5411 <br />Mailing Address <br />16021 W HWY 4 <br />STOCKTON, CA 95206 <br />Care of <br />ZECH, WILLIAM <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0001698 <br />Facility Name <br />VICTORIA ISLAND FARMS <br />Location <br />16021 W HWY 4 <br />STOCKTON, CA 95206 <br />Phone <br />310-659-5411 <br />Mailing Address <br />8530 WILSHIRE BLVD STE 301 <br />BEVERLY, CA 90211 <br />Care of <br />SHIELDS NATIONAL, INC <br />Location Code <br />99 - UNINCORPORATED AREA <br />BOS District <br />003 - MOW, VICTOR <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID <br />AR0001697 <br />Mail Invoices to <br />Facility <br />Account Name <br />VICTORIA ISLAND FARMS <br />Account Balance as of 4/30/2003: $0.00 <br />Program/Element and Description <br />Record ID Employee ID and Name <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />New Owner ID : <br />APN: <br />SIC Code: <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Status New Owner? Delete <br />2217 - APPLIANCE RECYCLER PR0521475 EE0007380 - STEVEN SHIH Inactive Y N A I D <br />4461 - SLUDGE/ASH SITE PR0440080 EE0000149 - RAYMOND BORGES Inactive 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 form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br />State and/or Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: ' $20.00 = <br />Water System to be TRANSFERED: " $155.00 = <br />Payment Type Check Number <br />RENS: Date <br />COMMENTS: <br />\\Phs-ehsq I-nt\apps\Envisions\Reports\5021.rpt <br />Amount Paid <br />Amount Paid <br />Account out: <br />Date / ! <br />Date / ! <br />Date <br />Received by <br />Date <br />