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Run by : SANDY San Joaquin County PHS/EHD Report #502lpenciL:FACILITY INFORMATION as of 11/19/96 <br /> Make changes/corrections in RED pen or <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date): <br /> OWNERSHIP CHANGE (date): <br /> OWNER ID: 0O481S VY.{�t',( C/ N Qwner ID: 0O S <br /> Owner Name: i" <br /> Owner DBA: K <br /> Owner Address: 2116 E WATERLOO RD <br /> STOCKTON, CA 95205 q V7 <br /> Home Phone: i l7 <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: 2116 E WATERLOO RD <br /> Care of: - i , i <br /> STOCKTON, CA 95205 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 006034 n L� TD� <br /> Facility Name: E K <br /> Location: 2116 E WATERLOO RD <br /> STOCKTON 95205 <br /> Phone: <br /> MaiLing Address: 2116 E WATERLOO RD Q,2 0%— ( l 1 <br /> Care of: � (' <br /> STOCKTON, CA 95205 <br /> Location Code: APN: <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0007594 New Account ID: 000 <br /> MaiL Invoices to: Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name: NAVONE ELECTRONICS (Circle one) <br /> Account BaLance as of 11/19/96 : $0 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee s Linked new owner? Delete <br /> _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _d_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br /> 2387 UST FACILITY (BEFORE 1/84) PR503962 0008 BRIGGS -INACTIVE 1 Y N A I D <br /> 7 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, 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 $150.00 = Amount Paid Date_/ / <br /> Payment Type Check # Recvd by <br /> RENS or COUNTER SUPV: Date/ /� ACCT out: p Date <br /> ___r—___ __________ <br /> _/ /� --_ <br />