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Date run : 7/17/00 3:43:16PM SANADQUIN COUNTY PUBLIC HEALTH SER*-S Report #: 0002 <br /> Run by AYOUNGBLOOD Facility Information as of 7/17/00 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0009092 <br /> Record lD <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0007092 Case Number: H01100 New Owner ID <br /> Owner Name: ECKERT COLD STORAGE <br /> Owner DBA• <br /> Owner Address <br /> Home Phone: Not Specified <br /> Work/Bussness Phone: 209-823-3181 <br /> Mailing Address; PO BOX 924 <br /> Care of- <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0009092 <br /> Facility Name: ECKERT COLD STORAGE <br /> Location: 757 S MOFFAT BLVD <br /> MANTECA, CA 95336 �@ <br /> Phone; 209-823-3181 <br /> Mailing Address: PO BOX 924 <br /> Care of; __.__RJ ---- —. _._ .__ ep— <br /> Location Code: APN; 221-040-26 <br /> BOS District: 005-CABRAL, ROBERT SIC code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0016092 New Account to: <br /> Mail Invoices to: Account Mail Invoices to: Owner/Facility/Account <br /> Account Name: ECKERT COLD STORAGE (Circle One) <br /> Account Balance as of 7/17/00: $0.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2226-CaIARP PROGRAM PR0514524 EE0000000-SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FI PR0509092 EE0000000-SJC OES Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511380 EE0000000-SJC OES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513633 EE0007289-YOUNGBLOOD Active Y N A I 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 and/or Federal <br /> Laws. <br /> APPLICANT'S SIGNATURE: Date / I <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Check Number Receipt Number Received by <br /> REHS: Date P_/ / ��nAccountout: Date_/=T.1-11-107 <br /> 1.0.0.89.00 <br />