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Dale run 11/15/2007 3:12:20P SAN JOIN COUNTY ENVIRONMENTAL HEADEPARTMENT Report 175021 <br /> Run by 4006 Pagel <br /> Facility Information as of 11/15/2 <br /> Record Selection Criteria: Facility ID FA0016228 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0013122 New Owner ID <br /> Owner Name GIANNECCHINI, STEVE ETAL <br /> Owner DBA BRITZ FERTILIZERS <br /> Owner Address 3651 JACK TONE RD <br /> STOCKTON, CA 95215 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 3651 JACK TONE RD <br /> STOCKTON, CA 95215 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016228 <br /> Facility Name BRITZ FERTILIZERS INC <br /> Location 7707 S JACK TONE RD <br /> STOCKTON, CA 95215 <br /> Phone <br /> Mailing Address PO BOX 60011 <br /> FRESNO, CA 93794 <br /> Care of STEVE GIANNECCHINI ETAL <br /> Location Code 99- UNINCORPORATED AREA APN 18117004 <br /> BOS District 002 - RUHSTALLER, LARRY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0028361 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name TERRACON CONSULTANTS (Circle One) <br /> Account Balance as of 11/15/2007: $-93.00 <br /> (Cirde One) <br /> Transfer to Active/Inache <br /> Program/Element and Description Record ID Employee ID and Name Status Nev,Owner? Delete <br /> 2950-ENVIRON ASSESS PR0524154 EE0000997-HARLIN KNOLL Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknovAedge that all site,and/or 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 /> Slate and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / I <br /> Water System to be TRA SFERED: '$372.00= Amount Paid 10.294Data <br /> Payment Type Check Number 6-1 O$-D Received byi <br /> REHS: Date / / Account out: Date / / <br /> COMMENTS: II ,,� ' <br /> LUw PAYMENT <br /> SC Y> \/ . <br /> NOv 15 2007 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpf A �' <br />