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Date run 10/19/01 11:46:29AM SAN&QUIN COUNTY fbgLyC HEALTH SEF*S Report #: 5023 <br /> Page #: 1 <br /> Run by Facility Information as of 10/19/01 <br /> Record Selection Criteria: Facility ID FA0006852 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> owner ID: OW 0010694 New Owner ID <br /> Owner Name: MILLER SPRINGS REMEDIATION MGT <br /> Owner DBA: <br /> Owner Address: 2480 FORTUNE DR STE 300 <br /> LEXINGTON, KY 40509 <br /> Home Phone: 859-543-2100 <br /> Work/Business Phone: Not Specified <br /> Mailing Address: 2480 FORTUNE DR STE 300 <br /> LEXINGTON, KY 40509 <br /> Care of: PRICE, KEN <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0006852 <br /> Facility Name: OCCIDENTAL CHEMICAL CORP <br /> Location: 1904 W CHARTER WY <br /> STOCKTON, CA 95205 <br /> Phone: 209-472-2020 <br /> Mailing Address: 2480 FORTUNE DR STE 300 <br /> LEXINGTON, KY 40509 <br /> Care of: PRICE, KEN <br /> Location Code: 01 -STOCKTON APN: 163-020-17/29 <br /> BOS District: 001 - GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> AccountlD: AR0009556 New Account ID: <br /> Mail Invoices to: Account Maillnvoicesto: Owner/Facility/Account <br /> Account Name: MILLER SPRINGS REMEDIATION MGT (Circle One) <br /> Account Balance as of 10/19/01: $43.50 <br /> (Clyde One) <br /> Transferto Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PRO505548 EE0000684-MICHAEL INFURNA 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 project specific,PHS/EHD houdycharges 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 /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: "$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: -*$150.00= Amount Paid Date /_/ <br /> Payment Type <br /> Check Number Received by <br /> REHS: Date_/_/ Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />