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Report#5021 <br /> Date nin 1/2/2006 10:16:19AI SAN JOAN COUNTY ENVIRONMENTAL HEAL&EPARTMENT Pagel <br /> Run V Facility Information as of 11/2/2006 <br /> Record Selection Criteria: Facility ID FA0007271 <br /> Make changes/corrections in RED ink or pencil. <br /> '"4FORMATION CHANGE(date) <br /> J, OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002955 �D ' <br /> Owner Name LINCOLN PROPERTIE: <br /> Owner DBA <br /> Owner Address 615 LINCOLN CENTEF <br /> STOCKTON, CA 95207 r �� <br /> Home Phone 209-478-9200 <br /> Work/Business Phone 209-478-9200 <br /> Mailing Address 615 LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Care of WILBUR SMITH <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007271 <br /> Facility Name LINCOLN CNTR ENV REMEDIATION TRUST <br /> Location PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone 510-237-1782 <br /> Mailing Address 137 PARK PLACE <br /> RICHMOND, CA 94801 <br /> Care of MARK ADAMS <br /> Location Code 01 -STOCKTON APN: <br /> BOS District 002 - MARENCO, DARIO SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Acco D AR0010736 New Account ID: <br /> Mail Invoices to ount Mail Invoices to: Owner / Facility / Account <br /> Account Name LINC R ENV REMEDIATION TRUST (Circle One) <br /> Account Balance as of 11/2/2006' $38 Tltj , (Circle One) <br /> Transfer to Active/InacNe <br /> New Omer? Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2960-RWQCB SITE PRO506203 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, a undersigned ovfner,operator or agent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly cF(a[{y� o Q frit this <br /> facility or activity will be billed to the party identified as in OWNER on this form. I also certify that all operations will be performed in accordance with all applicable ordi��o RA"-0I RECEIVED <br /> nd <br /> Slate and/or Federal Laws. fIAW1 f i'IT-- 5 <br /> APPLICANT'S SIGNATURE: Daten_������NOV 03 2006 <br /> Program Records to be TRANSFERED: '$20.00= ount Paid ��SAN <br /> a�0 f Date / ✓� / JOAQUIN COUNTY <br /> Water System to RAN ERED: '$372.00= mount Paid Date /_/ ENVIRONMENTAL <br /> H DEPARTMENT <br /> Payment Type Check Number 2 <br /> Re y L�J HEALT <br /> REHS: Date /_/ Account out: J�? Date--/—/ L-3 /.�. <br /> COMMENTS: / y� <br /> / t 7 E Vve <br /> \\ph s-e hsgl-nt\apps\envisions\reports\5021.rpt <br />