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Data run 12/212003 4:04:1 t Pt` SAN Jr 9UIN COUNTY ENVIRONMENTAL HE/ "H DEPARTMENT <br /> Report#5021 <br /> Ran by % , Facility Information as of 12/2/2%713 Pagel <br /> Record Selection Criteria: Facility ID FA0010111 Aso <br /> e�, <br /> T" Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> �// OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008111 New Owner ID <br /> Owner Name STOCKTON INTER TRANS CORP <br /> Owner DBA YELLOW CAB <br /> Owner Address 5000 S AIRPORT WAY 205 <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-462-8700 <br /> Mailing Address /g <br /> STOCKTON, CA 9520639W Sflv"K-P^t r CA 4Srole - bfQ1 F{ <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010111 <br /> Facility Name YELLOW CAB <br /> Location 7030 S C E DIXON ST <br /> STOCKTON, CA 95206 <br /> Phone 209-462-8700 <br /> Mailing Address 6364&-LINDBERGHST Lp` I-)C) <br /> STOCKTON,CA 952063901 4ct a <br /> Care of <br /> Location Code 01 -STOCKTON APN:177-260-09 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017111 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name YELLOW CAB (Circle One) <br /> Account Balance as of 12/2/2003: $0.00 <br /> (Circle One) <br /> Transfer to Activellwche <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner Delete <br /> 2220-SM HW GEN<5 TONSNR PR0514174 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512399 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PRO520874 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0510111 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I.Ma undersigned owner,operator or agent of same,acknowledge that all site.and/or project specific,PHS/EHD hourly charges associated with this <br /> facil y or activity will be billed to the party idandified as the OWNER on this form. I also certify Mal all operations will be performed in accordance with all applicable Ordinate Codes andror Standards and <br /> State andlor Federal Laws. <br /> APPLICANTS SIGNATURE: Date I / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: lDate�/ 02 /�3 Account out: Date Z/ /L <br /> COMMENTS: <br /> Pry �-ILII,�.y.Ld -t A(, � <br /> \\Phs�hsgl-nt\apps\Envisions\Reports\5021.rpt <br />