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e run : 10/18/00 10:08:37AM SANIVQUIN COUNTY PUBLIC HEALTH SER&S <br /> nby : VPEDRAZA Report #: 0002 <br /> Facility Information as of 10/18/00 Page #: 1 <br /> tecord Selection Criteria: FacilityID FA0009860 <br /> Record lD <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE (date <br /> Owner ID; OW0007860 Case Number: H05669 New Owner ID <br /> Owner Name: CARL A BLAIN <br /> Owner DBA. <br /> Owner Address <br /> Home Phone: Not Specified <br /> Work/Bussness Phone; 209-334-5303 <br /> Mailing Address; 11900 E LOCKE RD <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0009860 <br /> �ar,� ,��c� Mass <br /> Facility Name: WOLF MFG INC <br /> Location; 11900E LOCKS RD f <br /> LOCKEFORD, CA 95237 20 <br /> Phone; 209-334-5303 � �l <br /> a <br /> Mailing Address: 1450 E SCOTTS AVE <br /> STOCKTON, CA 95205-6250 <br /> Care of; CARL A BLAIN <br /> Location Code: 99 - UNINCORPORATED AREA APN: 051-160-04 <br /> BOS District: 004 - SEIGLOCK, JACK SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0016860 New Account ID:- <br /> Mail Invoices to; Account Mail Invoices to: Owner/-Facility/Account <br /> Account Name: WOLF MFG INC (Circle ne) <br /> Account Balance as of 10/18/00: $0.00 <br /> (Circle One) <br /> Program/Element and Description UST(s) Transfer to Active/Inactve <br /> P Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FI DR0509860 EE0000000-SJC OES Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512148 EE0000000-SJC DES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0514065 EE0006213-PEDRAZA Active Y N A 1, D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,and/or <br /> project specific, PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this <br /> form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State an Federal <br /> Laws. <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: `$150.00= Amount Paid Date <br /> Payment Type Check Number Receipt Number Received by <br /> REHS: i ,;vr, �— <br /> Date_0/ _/ �• Account out: Datecommr _���� /_�I3_/CL <br /> 1.0.0.89.00 <br />