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Run by : SANDY A Joaquin County PHS/EHD 6 Report #5021 <br /> FACILITY INFORMATION as of 01/21/97 <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date): <br /> OWNERSHIP CHANGE (date <br /> OWNER ID: 000172 New Owner ID: 00 lL_ <br /> owner Name: BOKIDES, MEL <br /> owner DBA: MEL BOKIDES PETROLEUM <br /> Owner Address: 265 E CANTERBURY <br /> STOCKTON, CA 95207 <br /> Home Phone: 209-364-6437 <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: 265 E CANTERBURY _ <br /> Care of: MEL BOKIDES PETROLEUM _ <br /> STOCKTON, CA 95207 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 003591 <br /> Facility Name: M B P* <br /> Location: 8203 E HWY 26 —rTT <br /> STOCKTON 95206 <br /> Phone: 209-943-2011 <br /> Mailing Address: 2191 NAVY DR <br /> care of: MEL BOKIDES <br /> STOCKTON, CA 95206 <br /> Location Code: 0 1 APN: <br /> BOB District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0003169 New Account ID: 000 <br /> Mail Invoices to: Owner Mail Invoices to: Owner / acility / ccount <br /> Account Name: BOKIDES, MEL (Circle o <br /> Account Balance as of 01/21/97: $510 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> PIE Description ID Employee Status Linked new owner? Delete <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> 2381 UST FACILITY (BEFORE 1/84) PR231595 0008 BRIGGS ACTIVE 3 Y N A I D <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <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 <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance'with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> PR Records to be TRANSFERED: x 820.00 = Amount Paid Date_ <br /> Water System to be TRANSFERED: x 8150.00 = Amount Paid Date / / <br /> Payment Type Check-# Recvd by <br /> REHS or COUNTER SUPV Date_/_/_ ACCT out: Dat,F/ /Ifl UNIT/File:_/_/_ <br />