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Date con 1/5/2006 4:62:50PM SAN J* 'IN COUNTY ENVIRONMENTAL HE DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1/5/20 <br /> Record Selection Criteria: Facility ID FA0015465 <br /> Make changes/corrections in RED ink or pencil. <br /> ME INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date). <br /> Owner ID OW0000925 New Owner ID <br /> Owner Name STONE BROS AND ASSOCIATES <br /> Owner DBA <br /> Owner Address 1024 W ROBINHOOD# 1 <br /> STOCKTON, CA 95207 <br /> Home Phone 209-478-1791 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1024 W ROBINHOOD#1 <br /> STOCKTON, CA 95207 <br /> Care of STONE BROS <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015465 <br /> Facility Name FORMR MONTGOMERY WARDS AUTO SR\ <br /> Location 5400-5606 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone 209-478-1791 <br /> Mailing Address 1024 W ROBINHOOD DR#1 <br /> STOCKTON, CA 95207 <br /> Care of STONE BROTHERS <br /> Location Code 01 -STOCKTON APN 10227008 <br /> BOS District 002- MARENCO, DARIO SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026684 New Account ID: <br /> Mail Invoices to ACCOun `` Mail Invoices to: Owner / Facility / Account <br /> Account Name ENSR—q g 2 e 4�^c'c- c" tQ, cN�k 0.VY— (Circle One) <br /> Account Balance as of 1/5/2006: $102.30 <br /> Transfer to (Circle One) <br /> Aclive/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 2957-UST FILE-RWQCB PRO522692 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/EMD 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 andror Federal Laws. <br /> APPLICANTS SIGNATURE: Date <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: �� Date <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\e nvisions\reports\5021.rpt <br />