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Report #: 5023 <br /> ]ate mn 9/14/01 12:26:39PM SAN ,1�4UIN COUNTY PUBLIC HEALTH SERfS Page #: 1 <br /> inn by Facility Information as of 9/14/01 <br /> 7ecord Selection 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 /> APN: <br /> Location Code: 01 -STOCKTON SIC Code: <br /> BOS District: 002-MARENGO, DARIO <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> New Account ID: <br /> Account ID: AR0003672 Mail Invoices to: Owner/Facility/Account <br /> Mail Invoices to: Facility (circle One) <br /> Account Name: AMERICAN MOULDING & MILLWORK <br /> Account Balance as of 9/14/01: $0.00 (circle one) <br /> Transfer to Active/Inaeve <br /> Program/Element and Description Record ID Employee 10 and Name <br /> 1 Status New Owner? Delete <br /> Active Y N A <br /> 295 ENVIRON ASSESS PR00 i6 EE0000756-CAROL OZ fictive Y N A I <br /> 2951 -UGT-CAP PRO504943 EE0000756-CAROL OZ Active Y N A <br /> 2953-LCL HW CLEANUP SITE PR0505272 EE0000756-CAROL OZ <br /> 4D D-gL6 � <br /> ratm or agent of same. <br /> facility or activity will be billed to the party identified as the OWNER on th s fowner,I allso certify that all ope ationskwille performed nge that all laccorda accordance all pp cable Ordinate es and/or sStandards andEll"LLING and COrPLIANCE ACKNOWLEDGEMENT: i,the undersigned <br /> s <br /> State and/or Federal Laws. <br /> Date <br /> APPLICANT'S SIGNATURE: •820.00= Amount Paid Date <br /> Program Records to be TRANSFERED: .$15000= Amount Paid Date <br /> water System to be TRANSFERED: . Received by <br /> Payment Type _Check Number Date <br /> Date Account out: <br /> REHS: <br /> COMMENTS: <br />