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Date run 10/11/2005 9:26:32A SAN JON COUNTY ENVIRONMENTAL HEAT EPARTMENT <br /> Run by <br /> ,I Report#5021 <br /> Facility Information as of 10/11/2005 Pagel <br /> Retard Selection Criteria: Fatality ID FA0014329 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0011381 New Owner ID <br /> Owner Name DEL MONTE FOODS <br /> Owner DBA <br /> Owner Address 205 N WIGET <br /> WALNUT CREEK, CA 94598 <br /> Home Phone 925-944-7275 <br /> Work/Business Phone Not Specified <br /> Mailing Address 205 N WIGET <br /> WALNUT CREEK, CA 94598 <br /> Care of DEL MONTE FOODS <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014329 <br /> Facility Name DEL MONTE CAR WASH <br /> Location 110 FILBERT ST <br /> STOCKTON, CA 95205 <br /> Phone <br /> Mailing Address 205 N WIGET <br /> WALNUT CREEK, CA 94598 <br /> Care of DEL MONTE FOODS <br /> Location Code APN: <br /> BOIS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024351 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name DEL MONTE CAR WASH (Circle One) <br /> Account Balance as of 10/11/2005: $Q 60/ <br /> (Circle One) <br /> Transfer to Active/I solve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Del to <br /> 2950-ENVIRON ASSESS PRO519160 EE0000684-MICHAEL INFURNA A e Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge That all site,and/ project spec,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 /> Slate and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: "$20.00= Amount Paid Date <br /> Water System to b RANSF RED: •$372.00= Amount Paid Date <br /> Payment Type Check Number Receiv d <br /> REHS: Date Account out: <br /> COMMENTS: <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />