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Date run 3/5/2003 1:32:16PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> � <br /> Facility Information as of 3/5/20, <br /> Record selection Criteria: Faclity,ID FA0010111 <br /> 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 n v1� c <br /> Mailing Address !93 (-q? <br /> L I rOb A i;: s 14 U L <br /> STOCKTON, CA 95206 To <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 // b <br /> Mailing Address <br /> STOCKTON, CA 95206 sao -3S 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 New Account ID: <br /> Mail Invoices to_9111111,10— Mail Invoices to: Owner / Facility / Account <br /> Account Name STOCKTON INTER TRANS CORP °> <br /> Account Balance as of 3/5/2003: $532.50 <br /> (Circle One) <br /> Transferto Activennache <br /> ProgranuElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO514174 EE0000000-HAZ MAT SJC IDES Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512399 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-IDES PR0520874 Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0510111 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ano or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be blled 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 anNor Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: �7-j,) MA 1,L Date 3 <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: Date / / Account out: Date / / <br /> COMMENTS: <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />