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Date run 7/14/2009 3:43:10PK SAN JO + O_UIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repod #5021 <br /> Run by 4006 0Paget <br /> Facility Information as of 7/14/2(, _ _ <br /> Record Selection Criteria: Facility ID FA0009202 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION SSN / Fed Tax ID <br /> Owner ID OW0007202 Case Number: H01964 New Owner ID <br /> Owner Name ERNESTFOPPIANO <br /> Owner DBA 6313 <br /> Owner Address L,dD G10 4Sz34� <br /> Home Phone Not Specified 4 Qb Ie �f 0 3 <br /> Work/Business Phone 209-474-0434 <br /> Mailing Address <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0009202 <br /> Facility Name STOCKTON CITY TAXI CAB CO INC <br />'i Location 2085 E FREMONT ST <br /> STOCKTON, CA 95205 <br /> Phone 209-466-3676 <br /> Mailing Address 20S&-E-FRE44GNTST{ <br /> Care of ERNEST R FOPPIANO <br /> Location Code Alt Phone <br /> BOS District Fax <br />'y APN 141 -112-23 EMail : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> j Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> AccountlD AR0016202 NewAcco <br /> Mail Invoices to Account Mail Invoices to: Own / Facility / Account <br /> Account Name STOCKTON CITY TAXI CAB CO INC circle One) <br /> Account Balance as of 7/14/2009: $0 .00 <br /> (Circle One) <br /> Transfer to Active/Inachie <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andkir project specific, 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 /> Stale and/or Federal Laws.APPLICANT'S SIGNATURE: ff� � E7 ( r / &il-) CD Date –J—/_jy_( <br /> Program Records to be TRANSFERED: * $20.00 = Amount Paid Date / / <br /> Water System to be TRANSFERED: ' $372.00 = Amount Paid Date / / <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: r✓y Date /0 _ <br /> COMMENTS: / <br /> \\eh-env\envision\reports\5021 .rpt <br />