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Dale runt 1/3/2003 3:18:OOPM ' SAN JO Pagel jr COUNTY ENVIRONMENTAL HEM#DEPARTMENT asort <br /> Run by Pagel <br /> Facility Information as of 1/3/20 <br /> Record Selection Criteria: Facility ID FA0004083 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0003001 New Owner ID <br /> Owner Name CCJS LIMITED PARTNERSHIP <br /> Owner DBA RE MANUFACTURING INC <br /> Owner Address 6653 EMBARCADERO DR STE M <br /> STOCKTON, CA 95219 <br /> Home Phone 209-943-1981 <br /> Work/Business Phone 209-943-1981 <br /> Mailing Address 6653 EMBARCADERO DR <br /> STOCKTON, CA 95219 <br /> Care of BRANDON SCOTT <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004083 <br /> Facility Name RE MANUFACTURING INC <br /> Location 1825 E CHARTER WAY <br /> STOCKTON, CA 95208 <br /> Phone 209-943-1981 <br /> Mailing Address 6653 EMBARCADERO DR <br /> STOCKTON, CA 95219 <br /> Care of BRANDON SCOTT <br /> Location Code 01 -STOCKTON APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003743 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ADVANCED GEO ENVIRONMENTAL (Circle One) <br /> Account Balance as of 1/3/2003: $144.00 <br /> (Circle One) <br /> Transfer to <br /> Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New OwneR Delete <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0009048 EE0000684-MICHAEL INFURNA Active 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 speck,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 Ortlinace Codes and/or Standards and <br /> State andror Federal Laws. <br /> APPLICANT'S 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: nDate <br /> COMMENTS: n /�// ' YV✓" [/ .� (/ // �GLwC'{'i�) <br /> n ('V(,i(//////yam/ <br /> ` fC <br /> J1M.2 <br /> X'g�3�fa � <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />