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on it6/2/2005 4:56:03PM SAN JOIN COUNTY ENVIRONMENTAL HEA10 DEPARTMENT Rep #5021 <br /> R . 5290 Pagel <br /> Facility Information as of 6/2/2005 <br /> Record Sale. 'niana: Facility ID FA0015622 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0012568 New Owner ID <br /> Owner Name HERREERA, GARLOSA <br /> Owner DBA <br /> Owner Address 1443 APRICOT AVE <br /> PATTERSCN, CA 95363 <br /> Home Phone 209-892-7363 <br /> Work/Business Phone 209-469-0656 <br /> Mailing Address 1443 APRICOT AVE <br /> PATTERSON, CA 95363 <br /> Care of HERRERA, CARLOSA <br /> FACILITY FILE INFORMATION ��f <br /> Facility Ie UNITE W � � O "' Q� <br /> 22 <br /> Facility Name UNITED WOOD WORKS <br /> Location 4843 E FREMONT <br /> STOCKTON, CA 95215 <br /> Phone 209-469-0656 <br /> Mailing Address 1443 APRICOT AVE <br /> PATTERSON, CA 953639752 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN:NO APN IN PV <br /> BOS District 002 - MARENCO, DARIO SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026987 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name UNITED WOOD WORKS (Circle One) <br /> Account Balance as of 6/2/2005: $424.00 <br /> T (Circle One) <br /> Transfer to <br /> Activennaclve <br /> Progrann Element and Description Record ID Employee ID and Name Status N.Owner? Delete <br /> 2220-SM HW GEN c5 TONS/YR PRO523134 EE0008373-JOHN JACKSON Active Y N I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: t,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associL with this <br /> facility a activity will be billed to the party identified as the OWNER on this form. I also certify that all operations volt he performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S 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 bv <br /> REHS: Date / / Account out: Date / O d/ DS- <br /> COMMENTS <br /> \\phs-ehsgl-nttapps\envisions\reports\5021.rpt <br />