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Data run 8/12/2014 9:42:11AN S*0IN COUNTY ENVIRONMENTAL DEPARTMENT Report#5o21 <br /> Run by 127$ Pagel <br /> Facility Information as of 8112/2014 <br /> Record Selection Criteria: Facility ID FA0022391 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(dale) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0019138 New Owner ID <br /> OwnerNamej&%,STORES INC 7-5 5 <br /> Owner DBA <br /> Owner Address 1050 W HAMPDEN AVE <br /> ENGLEWOOD, CO 80110-2118 <br /> Home Phone Not Specified <br /> WorWBusiness Phone Not Specified <br /> Mailing Address 1050 W HAMPDEN AVE <br /> ENGLEWOOD, CO 80110-2118 <br /> Care of B A STORES INC <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0022391 <br /> Facility Name SPORTS AUTHORITY <br /> Location 3150 N NAGLEE RD <br /> TRACY, CA 95304 <br /> Phone <br /> Mailing Address 1050 W HAMPDEN AVE <br /> ENGLEWOOD. CO 80110-2118 <br /> Care of B A STORE INC <br /> Location Code 03-TRACY Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 21205052 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0040982 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SPORTS AUTHORITY (Circle one) <br /> Account Balance as of 8/12/2014: $-375.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> PrograMElement and Description Record ID Employee ID and Name Stews New OwnsO Delete <br /> 1921 -HMBP-Regular-Primary Location PR0539004 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSIEHD hourly charges associated with this facility <br /> 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 Ordinance Codes andor Standards and State andor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date /_/ <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid DateWater System <br /> Payment Type to be TRANSFERED'Check Number Amount Paid— Date <br /> Receive[N—brr/ <br /> RENS: Date_/ / Account out: l`-'r Date <br /> COMMENTS: <br />