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E <br /> 9/14/01 12:26:39PM SAN�6IUIN COUNTY PUBLIC HEALTH SE*_S Report Facility Information as of 9/14/01 Pageection Criteria: Facility ID FA0004032 <br /> Make changes/corrections 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: HUGHES, J P <br /> Owner DBA: AMERICAN MOULDING & MILLWORK <br /> Owner Address: 288 ROOTHILL DR <br /> SUTTER CREEK, CA 95685 <br /> Home Phone: 209-267-0433 <br /> Work/Business Phone: 209-946-5880 <br /> Mailing Address: 2801 WEST LANE <br /> STOCKTON, CA 95208 <br /> Care of: J P HUGHES <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0004032 <br /> Facility Name: AMERICAN MOULDING & MILLWORK <br /> Location: 2801 WEST LN <br /> STOCKTON, CA 95208 <br /> Phone: 209-946-5880 <br /> Mailing Address: 2801 WEST LANE <br /> STOCKTON, CA 95208 <br /> Care of: J P HUGHES _ <br /> Location Code: 01 -STOCKTON APN: <br /> BOS District: 002- MARENCO, DARIO SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0003672 New Account ID: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: AMERICAN MOULDING & MILLWORK (Circle one) <br /> Account Balance as of 9/14/01: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> ENV IRON ASSESS PR0009016 EE0000756-CAROL OZ Active Y N A I D UGT-CAP PRO504943 EED000756-CAROL OZ Active Y N A(297 LCL HW CLEANUP SITE PR0505272 EE0000756-CAROL OZ Active Y N A <br /> k� cl �¢ 0 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned on thi owner,operator or agent all <br /> same,acknowledge that all site,and/orprojectwith <br /> specific,able OriEHD 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 operafbns will be performed in accordance wim all applicable Ordinate Codes and/or Standards arid <br /> Stale 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: '$150.00= Amount Paid Date <br /> Payment Type Check Number Rece' by ��t ^ I' <br /> REHS: Date / / Account out: Date /ri_/� <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />