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3/2006 4:28:51 Ph SAN JOi IN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> OIt Facility Information as of 5/23/20 Pagel <br /> .lion Criteria: Facility ID FA0004032 <br /> Make changeslcortections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002967 New Owner ID <br /> Owner Name Hyg}{Eg-rp 61 I L L C./2.r—�c_ )QV0"1.KecrlT Ll--ST�� <br /> Owner DBA AMERICAN MOULDING & MILLWORK [.LL <br /> Owner Address 2$g BR S1 //lL fJ EE//L/Y, /CT5-0-7 <br /> - -/ <br /> SUTTER <br /> &REE i, nn 95605 R LA(LL 0 CA R q J 0 1 <br /> Home Phone �zQ7--04@Z <br /> Work/Business Phone ',g9-946-6880. <br /> Mailing Address 2tol--yyEST-LANE <br /> STOCKTON—,efit-952e& 57W <br /> Care of J P HUGHES <br /> FACILITY FILE INFORMATION Site Mitigation R cility <br /> Facility ID FA0004032 Site Mitigation F cility <br /> Facility Name AMERICAN MOULDING & MILLWORK Site Mitigation F cility <br /> Location 2801 WEST LN (Lrn A-rt-c l-c0 /a Gs <br /> STOCKTON, CA 95208t�t <br /> Phone 209-946-5880 <br /> Mailing Address 2801 WEST LANE <br /> STOCKTON, CA 95208 <br /> Care of J p HUGHES <br /> Location Code 99- UNINCORPORATED AREA A N:11709001 <br /> BOIS District 002 - MARENCO, DARIO SIC Co e: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003672 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name MACTEC ENGINEERING &CONSULTING (Circle One) <br /> Account Balance as of 5/23/2006: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Stltus New Owner? Delete <br /> 2951 -UGT-CAP PRO504943 EE0000756-CAROL OZ Inactive Y N A I D <br /> 2953-LCL HW CLEANUP SITE PR05UE2 EE0000756-CAROL OZ Inactive Y N A I D <br /> 2960-RWQCB SITE R0009016. £E$OOgB7 g-2AR6L-9c� Active Y N A I D <br /> i ax) & 1 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge At all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activitywill 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 Ordmace Codes and/or Standards and <br /> State and/or Federal Laws. ,t <br /> APPLICANT'S SIGNATURE: O� A4TA-CQ,_ Date 5 / a3/ O <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Dat / / <br /> Water System to be TRANSFERED: '$372.00= Amount Paid 4S27 1 Date��Z.3 / 0� <br /> Payment Type ✓ Check Number 4 4 (YO-2- Received bv <br /> REHS: �ia f� &)a e] G Date---S—/ a',3 Account out: Date / _/ C7 L <br /> COMMENTS: <br /> \aO\1604 RECEIVED <br /> Illy MAy 2 3 2006 <br /> SAN N0R00ME OMEN <br /> HEALTH DEPAR <br /> \\p hs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />