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Date run 1/27/2004 9:47:28AN SAN JO, IN COUNTY ENVIRONMENTAL HEAI DEPARTMENT Report#5021 <br /> Run by . —0 Pagel <br /> Facility Information as of 1/27/2004 <br /> Record Selection Criteria: Facility ID FA0007724 <br /> Make changes/corrections in RED ink or pencil. <br /> J 1 INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0006381 New Owner ID <br /> Owner Name STOCKTON PORT DISTRICT <br /> Owner DBA HYDRO-AGRI <br /> Owner Address PO BOX 2485 <br /> LOS ANGELES, CA 90051 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 2485 <br /> LOS ANGELES, CA 90051 <br /> Care of STOCKTON PORT DISTRICT <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007724 <br /> Facility Name HYDRO-AGRI <br /> Location 3019 NAVY DR <br /> STOCKTON, CA 95201 <br /> Phone <br /> Mailing Address 100 N TAMPA ST STE 3200 <br /> TAMPA, FL 33602 <br /> Care of HYDRO-AGRI <br /> Location Code APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0013420 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name HYDRO-AGRI (Circle One) <br /> Account Balance as of 1/27/2004: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0507169 EE0000684-MICHAEL INFURNA Inactive 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 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: •$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> 1tkt ed� Ole <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br /> lay <br />