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Date nun 9/14/2005 11:45:01AI SAN JO TJIN COUNTY ENVIRONMENTAL HEAT I DEPARTMENT Report#5021 <br /> Run by 4006 Pagel <br /> Facility Information as of 9/14/2000 <br /> Record Selection Criteria: Facility ID FA0010876 <br /> "LIE Make changes/corrections in RED' k or pencil. <br /> INFORMATION CHANGE <br /> OWNERSHIP CHANGE <br /> OWNER FILE INFORMATION <br /> aw <br /> Owner I OW0008876 Case Number: H08910 New Owner ID <br /> Owner Name NUGENERATION TECHNOLOGIES LLC <br /> Owner DBA NU GENERATION TECHNOLOGIES LLC <br /> Owner Address U U lLO 5 SioAJ A L <br /> 7� d <br /> Home Phone Not Specified vo H a OLT9 QLf g z�—Z c3 <br /> Work/Business Phone 209-234-5930 <br /> Mailing Address (Q-� <br /> s/A <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010876 <br /> Facility Name NUGENERATION TECHNOLOGIES LLC <br /> Location 7200 S CE DIXON ST <br /> STOCKTON, CA 95206 <br /> Phone 209-234-5930 <br /> Mailing Address pQL$Qv X0¢2$ 5.1 A <br /> Care of <br /> Location Code 99 - UNINCORPORATED AREA APN 17726009 <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017876 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name NUGENERATION TECHNOLOGIES LLC (Circle One) <br /> Account Balance as of 9/14/2005: $66.00 <br /> (Circle One) <br /> Transfer to Acgve/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status N.Ovmen Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514442 EE0008389-DENNIS CATANYAG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO513164 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PR0514882 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO520529 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPR0510876 EE0000000-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,and/or project specific,PHS(EHD hourly charges associated with this <br /> facility or activity will be billed to the parry 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. 1� \ G� <br /> APPLICANTS SIGNATURE: 1 1 lA t t-^ K M�/V Date 7 / -7 / �S <br /> Program Records to be TRANSFERED: `$20.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: `$558.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> RENS: Date_/ / Account out: __706i Date 2/ _/_0= <br /> COMMENTS: <br /> A- J <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />