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Date run : 7/25/00 11:19:51AM SA r AQUIN COUNTY PUBLIC HEALTH SEr '.ES <br />Run by LTURKATTE Facility Information as of 7/25/00 <br />Record Selection Criteria: Facility ID FA0002729 <br />OWNER FILE INFORMATION <br />Owner ID: <br />OW0002060 <br />Owner Name: <br />PAN AMERICAN SAVINGS BANK <br />owner DBA: <br />PHOENIX APARTMENTS <br />Owner Address: <br />1300 SEL CAMINO REAL <br />Phone: <br />SAN MATEO, CA 94402 - <br />Home Phone: Not Specified <br />Work/Bussness Phone: 209-957-5844 <br />Mailing Address: 1300 S EL CAMINO REAL <br />SAN MATEO, CA 94402 - <br />Care of: PAN AMERICAN SAVINGS BANK <br />FACILITY FILE INFORMATION <br />Facility ID: <br />FA0002729 <br />Facility Name: <br />Location: <br />803 E HAMMER LN <br />STOCKTON, CA 95210 <br />Phone: <br />209-957-5844 <br />Mailing Address: 803 E HAMMER LANE <br />STOCKTON, CA 94402 - <br />Care of: OFFICE <br />Location Code: 01 -STOCKTON <br />Bos District: 003 - SIMAS, EDWARD <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID: AR0004447 <br />Mail Invoices to: Facility <br />Account Name: PHOENIX APARTMENTS <br />Account Balance as of 7/25/00: $0.00 <br />Report #: 0002 <br />Page #: 1 <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />New Owner I �• <br />-(an,pty rL � ��rth.e� opts . <br />PAYMENT <br />RECEIVED APN, <br />SIC Code: <br />JUL 2 5 2000 <br />SAN JOAQUIN COU Account ID:: <br />PUBLIC HEALTH SERVI voices to: <br />ENVIRONMENTAL HEALTH �ibM <br />Owner / Facility / Account <br />(Circle One) <br />07.�DDa-- <br />(Circle One) <br />UST(s) Transfer to Acbve/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br />3611 - PUBLIC POOL/SPA-PRI MARY PR0360142 EE0000321 - OLIVEIRA Active Y N A I D <br />3612 - PUBLIC POOUSPA-ADDITIONAL PR0360262 EE0000321 - OLIVEIRA Active Y N <br />3612 - PUBLIC POOUSPA-ADDITIONAL PR0360263 EE0000321 - OLIVEIRA Active Y N <br />3612 - PUBLIC POOUSPA-ADDITIONAL PR0360264 EE0000321 - OLIVEIRA Active Y N <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or <br />project specific, PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this <br />form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal <br />Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED- "w " $0.00A AfA&nt Paid Date <br />Water System to be T NSFERED: " $150.00 = Amount Paid 0 Date— -7 / aPl C7 D <br />Payment Type Check Number ReCgipt Number Received bby /4 <br />RENS: ` Date / _. 10 Account out: Date I/ I !des /oo <br />MM <br />¢ Z 0.. 0 Q re -e- - -71a5 �o o — '--kA l jo <br />1.0.0.69.00 <br />