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Date run 12/9/2002 7:57:57AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/9/2002 <br /> Record Selection Criteria: Facility ID FA0012321 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0004106 New Owner ID <br /> Owner Name SPINGOLO <br /> Owner DBA GRAYLIFT INC <br /> Owner Address 1101 N BROADWAY <br /> STOCKTON, CA 95205 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-948-9641 <br /> Mailing Address PO BOX 5186 <br /> STOCKTON, CA 95205 <br /> Care of GRAYLIFT INC <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012321 <br /> Facility Name FORMER GRAYLIFT INC FACILITY <br /> Location 3131 E FREMONT ST <br /> STOCKTON, CA 95205 <br /> Phone 209-948-9641 <br /> Mailing Address 3131 E FREMONT ST <br /> STOCKTON, CA 95205 <br /> Care of GRAYLIFT INC <br /> Location Code 99- UNINCORPORATED AREA APN: <br /> BOS District 001 - GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0020114 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SUNTAG & FEVERSTEIN (Circle One) <br /> Account Balance as of 12/9/2002: $0.00 <br /> (Circle )_ <br /> Transfer to Active, nactve,' <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? <br /> 2950-ENVIRON ASSESS PR0515745 EE0000684-MICHAEL INFURNA Active 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 specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identfed 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 7"/ U 7i- Account out: 4Date 1 Zl o d Z" <br /> COMMENTS: <br /> \\Ph s-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />