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i <br /> Date run 11/4/2003 11:16:54AI SAN JO IN COUNTY ENVIRONMENTAL HEAD DEPARTMENT <br /> Run by Report#5021 <br /> Facility Information as of 11/4/2003 Pagel <br /> Record Selection Criteria: Facility ID FA0014676 <br /> I <br /> Make changes/corrections in RED ink or pencil. <br /> 'r <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011685 New Owner ID <br /> Owner Name RISHWAIN, JOSEPH T JR <br /> Owner DBA <br /> Owner Address 14 W ROBINHOOD DR <br /> STOCKTON, CA 95207 <br /> Home Phone 209-870-7771 <br /> 1 <br /> Work/Business Phone Not Specified I <br /> Mailing Address 14 W ROBINHOOD DR <br /> STOCKTON, CA 95207 <br /> Care of RISHWAIN, JOSEPH T <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014676 <br /> i <br /> Facility Name RISHWAIN, RAYMOND <br /> t <br /> Location 48 N WILSON WAY <br /> STOCKTON, CA 95205 <br /> Phone f <br /> l <br /> Mailing Address 14 W ROBINHOOD DR <br /> STOCKTON, CA 95207 r <br /> Care of JOSEPH T RISHWAIN JR <br /> Location Code 01 -STOCKTON APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION I <br /> i <br /> Account ID AR0024969 New Account ID: <br /> Mail Invoices to Facility 'Mail Invoices to: Owner / Facility / Account t <br /> Account Name RISHWAIN, RAYMOND (Circle One) <br /> Account Balance as of 11/4/2003: $0.00 / 1 <br /> 'I (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> i <br /> 2950-ENVIRON ASSESS PR0521601 EE0000684-MICHAEL INFURNA A e Y N A D t <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD 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 /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid i Date <br /> Water System to b NSF ED: "$155.00= Amount Paid Da <br /> Payment Type k Check Number P R cejyAi <br /> i <br /> RENS: Date_�/ / Account out: ate <br /> COMMENTS: <br /> n i <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt , <br />