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Date run 1/18/2005 10:33:17AI SAN JO^'JUIN COUNTY ENVIRONMENTAL HEAr"LI DEPARTMENT Report#5021 <br /> Run by 1�1 Facility Information as of 1/18/20DS Paget <br /> Record Selection Criteria: Facility ID FA0010470 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008470 Case Number: H08165 New Owner ID <br /> Owner Name CONCORD GEN CORP t lt > GS <br /> Owner DBA BISHOP INDUSTRIES 9 /17EI1 D <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-823-9388 <br /> Mailing Address 551 CARNEGIE ST <br /> MANTECA, CA 95337 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010470 <br /> Facility Name BISHOP INDUSTRIES INC <br /> Location 551 CARNEGIE ST <br /> MANTECA, CA 95337 <br /> Phone 209-823-9388 <br /> Mailing Address 551 CARNEGIE ST <br /> MANTECA, CA 95337 <br /> Care of <br /> Location Code 04 -MANTECA APN 22119002 <br /> BOS District 005-ORNELLAS, LEROY SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017470 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name CONCORD GEN CORP (Circle One) <br /> Account Balance as of 1/18/2005: $0.00 <br /> Transfer to (Circle Ona) <br /> Active/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514339 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512758 EE0000000-HAZ MAT SJC OES Inactive Y N A 1 D <br /> 2244-PACT TRANSFER RECORD-OES PR0520337 EE000o000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0510470 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned!owner,operator w agent of same,acknowledge that all site,and/or project specific.PHS/EHD hourly charges associated with this <br /> facility or activity vnll 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 /> Stale and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <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 It 'o <br /> REHS: Date / / Account out: Date /�_/ D, <br /> COMMENTS: <br /> tlphs-ehsql-nttappstenvisionstreportst5021.rpt <br />