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Date run 6/11/2008 9:41:59AN SAN JOIN COUNTY ENVIRONMENTAL HEAQ DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/11/2008 <br /> Record Selection Criteria: Facility ID FA0013383 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0010518 New Owner ID <br /> Owner Name BENNET, TIM <br /> Owner DBA SAN JOAQUIN VALLEY ASSOCIATES <br /> Owner Address 2333 SAN RAMON VALLEY BLVD <br /> SAN RAMON, CA 94903 <br /> Home Phone 925-820-6677 <br /> Work/Business Phone Not Specified <br /> Mailing Address 411 YOKUT AVE#107 <br /> STOCKTON, CA 95207 <br /> Care of CROSSWINDS OF CALIF (SFD DEV) <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013383 �� V <br /> Facility Name BRIDGEPORT TRAILS DEVELOPMENT <br /> Location 1904 CHARTER WAY <br /> STOCKTON, CA 95206 <br /> Phone <br /> Mailing Address 411 YOKUT AVE#107 <br /> STOCKTON, CA 95207 <br /> Care of CROSSWINDS OF CALIF <br /> Location Code Aft Phone <br /> BOB District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name SAN JOAQUIN VALLEY ASSOCIATES <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022283 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name GLENN SPRINGS HOLDINGS INC (Circle One) <br /> Account Balance as of 6/11/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> ProgramfElemenl and Description Record ID Employee ID and NameStatus New OwneO Delete <br /> 2960-RWQCB SITE PRO517372 EE0000684-MICHAEL INFURNA A live Y N A (il D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,antllo'pr ct spec,PHS/EHD hourly charges associa ed 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 Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to b TRAN FERED: "$372.00= Amount Paid Date <br /> Payment Type Check Number Recei <br /> REHS: Date / / Account out: Date / / <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />