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Date run 3/27/2009 11:33:35AI SAN JOIN COUNTY ENVIRONMENTAL HEAL Report#5021 <br /> DEPARTMENT Pagel <br /> Run by 1273 Facility Information as of 3/27/20 <br /> Record Selection Criteria: Facility ID FA0014710 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011721 New Owner ID <br /> Owner Name DAVE SCOFFONE <br /> Owner DBA ATS <br /> Owner Address 2986 LOOMIS RD of'jZ� 1A <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified �L <br /> Work/Business Phone 510-623-0560 <br /> Mailing Address PO BOX 30187 <br /> STOCKTON, CA 95213 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014710 QL <br /> Facility Name ATS <br /> Location 2985 LOOMIS RD <br /> STOCKTON, CA 95205 <br /> Phone 209-942-1155 <br /> Mailing Address PO BOX 30187 <br /> STOCKTON, CA 95213 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 17911023 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID <br /> AR0025017 New Account ID: <br /> Mail Invoices to Owner <br /> Mail Invoices to: Owner / Facility / Account <br /> Account Name DAVE SCOFFONE (Circle One) <br /> Account Balance as of 3/27/2009: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2244-PACT TRANSFER RECORD-OES PR0521636 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 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 /> 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: "$372.00= Amount Paid Date <br /> Payment Type Check Number Rece e <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />