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Run by : STAFFSarl-Joaquin County PHS/EHD <br /> Report #5021 FACILITY INFORMATION as of 05/19/95 <br /> ------------------------------------------------------------------------------- <br /> Make changes/corrections in RED pen or pencil- <br /> OWNER FILE INFORMATION Date of INFORMATION CHANGE: <br /> Date of OWNERSHIP CHANGE: <br /> OWNER ID: 002669 New Owner ID: 0 0 <br /> Owner Name: AMERICAN SAVINGS BANK <br /> Owner DBA: AMERICAN SAVINGS BANK <br /> Owner Address: 400 E MAIN ST 4TH FLOOR <br /> STOCKTON, CA 95290 <br /> Home Phone: 209-546-2434 <br /> Work/Business Phone: 209-983-4099 <br /> Mailing Address: 400 E MAIN ST 4TH FLOOR <br /> Care of: AMERICAN SAVINGS BANK <br /> STOCKTON, CA 95206 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 004093 / <br /> Facility Name: AMERICAN SAVINGS BANK J <br /> Location: 222 N EL DORADO ST <br /> STOCKTON 95202 <br /> Phone: 209-546-2434 <br /> Mailing Address: PO 110X 9 6 9 <br /> Care of: AM '' S I GS AN / HOLLAND /Z 8-75 //QA/ <br /> IWIN 27 3 9689 11NC—' C/f a / <br /> Ti2Fdo�2 S�nrTZ��f2 <br /> Location Code: 01 APN: 139-100-19-2 <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0003753 New Account ID: 000 <br /> Mail Invoices to: -A�eIrl't Mail Invoices to: Owner / Facility <br /> Account Name: CRC ENVIRONMENTAL RISK MGMT �^ <br /> Account Balance as of 0 5/19/9 5 . $ 280 . 80 <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> ------------------------------------------------------------------------------- <br /> 2953 LCL HW CLEANUP SITE PR009146 0684 INFURNA ACTIVE Y N A _ I D <br /> PUBLIC WATER SYSTEM <br /> ------------------------------------------------------------------------------- <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, 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 <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date-/-/9 <br /> ------------------------------------------------------------------------------- <br /> Programs to be TRANSFERED: x = Amount Paid Date _/_/9_ <br /> Payment Type Check # T Recvd by <br /> REHS or COUNTER SUPV /'qDate / � /9s ACCT out: Date/ 3/9 j UNIT/File:-/-/9_ <br />