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Report 715021 <br /> ERecord <br /> "- 4/16/2002;;fy25AI ;FA0006423 <br /> O[&�N COUNTY ENVIRONMENTAL HEAL 1`EPARTMENT Paget <br /> i Facility Information as Of 4/16/200 <br /> Selection Criteria: ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0005463 New Owner ID <br /> Owner Name BAFAIZ, SOHAIL/BAFAIZ, KHALIL <br /> Owner DBA <br /> Owner Address 39 E FERDINAND ST <br /> TRACY, CA 95376 <br /> Home Phone 209-830-1304 <br /> Work/BusinessPhone 510-881-1951 <br /> Mailing Address 39 E FERDINAND ST <br /> TRACY, CA 95376 <br /> Care of SOHAIL AND KHALIL BAFAIZ <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006423 <br /> Facility Name MAIN STREET BEACON#474 <br /> Location 3440 E MAIN ST <br /> STOCKTON, CA 95205 <br /> Phone 209-463-7716 <br /> Mailing Address 3440 E MAIN ST <br /> STOCKTON, CA 95205 <br /> Care of SOHAIL BAFAIZ&KHALIL BAFAIZ APN:15716002 <br /> Location Code 99 - UNINCORPORATED AREA SIC Code: <br /> BOS District 002 -MARENCO, DARIO <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> New Account ID: <br /> Account ID AR0009105 <br /> Mail Invoices to: Owner / Facility / Account <br /> Mail Invoices to Facility (Circle One) <br /> Account Name MAIN STREET BEACON#474 <br /> Account Balance as of 4/16/2002: $0.00 (Circle one) <br /> Transfer to Active/Inzctve <br /> New Owner? Delete <br /> Program/Element and Description <br /> Record ID Employee ID and Name Status <br /> 1615-RETAIL MKT<2000 SO FT(PREPKGD ONLYPR0161544 EE0006213-VIDAL PEDRAZA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512638 EE0000000-HAZ MAT SJC IDES Active Y N A I D <br /> 2301 -UST STATE SURCHARGE PR0507753 EE0000008-LETITIA BRIGGS Inactive Y N A 1 D <br /> 2361 -NEW MULTI UST FACILITY PR0231173 EE0000008-LETITIA BRIGGS Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0507625 EE0000008-LETITIA BRIGGS Active <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 /> Slate and/or Federal Laws. <br /> APPLICANTS 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 by <br /> REHS: Date Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />