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i <br /> Run by : STAFF San Joaquin County PHS/EHD <br /> -------------------`FACILITY- INFORMATION as of 10/24'�97 Report #5021 <br /> -------- ------------------- <br /> I�- --'MI -- <br /> OWNER FILE INFO I ------------------------ <br /> INFORMATION ON Make changes/corrections in RED pen or penc±2: <br /> INFORMATION CHANGE (date) : <br /> I OWNERSHIP CHANGE (date) : <br /> OWNER ID: 006202 I <br /> Owner Name: STOCKTON SAVINGS BANK New Owned ID: V <br /> Owner DBA; <br /> Owner Address: 501 W WEBER AVE I '� <br /> STOCKTON, CA 95201 l! <br /> Home Phone: 209-547-7610 'I <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 01 CORPORATION Lj <br /> 3 <br /> Mailing Address: 501 W WEBER AVE F I <br /> Care of; TOM BUGARIN I �k <br /> STOCKTON, CA 95201 <br /> FACILITY FILE INFORMATION <br /> ,I I <br /> FACILITY ID: 007504 <br /> I <br /> Facility Name: STOCKTON SAVINGS BANK <br /> Location: 501 W WEBER AVE <br /> STOCKTON 95201 <br /> Phone: 209-547-7610 E i <br /> Mailing Address: 501 W WEBER AVE <br /> Care of: TOM BUGARIN 'p <br /> STOCKTON, CA 95201. <br /> } <br /> Location Code: APN: i n <br /> BO5 District: SIC Code: x <br /> i <br /> i <br /> I <br /> ACCOUNTS RECEIVABLE FILE INFORMATION I <br /> ACCOUNT ID: 0011759 <br /> New Accoun I ID: i 000 <br /> Mail Invoices to: Account Mail Invoices to: <br /> ; Owner / Faculty / Account. <br /> Account Name: GUARANTY FEDERAL BANK {Circle one) <br /> Account Balance as of 10/2 4/9 7 : $0 . 00 {Circle one) <br /> Record UST(s) (Transfer to Activate / Inactivate <br /> 1.P/E Description ID Employee Status Linked new owner? Delete t <br /> ------------------------------------------------------f------------------------- <br /> 2950 ENVIRON ASSESS PR506564 4684 INFURNA INACTIVE � I! Y N A I D <br /> ---------------------------------------------------------------------------------- <br /> BILLING <br /> -- ----------------------BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> '1, M <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in.accordance with all applicable SAN JOAQUIN <br /> y <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: k Date <br /> --------------------------------------------------r ---'F <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid f777 Date <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid Oji !� Date-/F / <br /> Payment Type Check # ip Recvd by <br /> _ ___=__---''- <br /> REHS or COUNTER SUPV; Date / / ACCT out: Date�. / / - UNIT/File: <br /> i <br /> k <br /> I <br /> I 4 <br /> 7 1� <br /> �'� IIiL it <br />