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J <br /> r <br /> Date run 41/19/2013 9:05:23A SAN J UIN COUNTY ENVIRONMENTAL HEAW DEPARTMENT Report#5G21 <br /> Run by Pagel <br /> Facility Information as of 11/19/2013 <br /> Record Selection Criteria: Facility ID FA0010910 <br /> Make changes/corrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008734 New Owner ID <br /> Owner Name VERIZON WIRELESS INC <br /> Owner DBA <br /> Owner Address 2785 MITCHELL DR BLD9 1STFL <br /> WALNUT CREEK, CA 94598 <br /> Home Phone 925-527-9600 <br /> Work/Business Phone Not Specified <br /> Mailing Address 2785 MITCHELL DR BLDG 9 IST FLR <br /> WALNUT CREEK, CA 94598 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS IDS' 10,144,653 <br /> Facility Name VERIZON WIRELESS-PATTERSON PASS <br /> Location 24383 S PATTERSON PASS RD <br /> TRACY, CA 95376 <br /> Phone 925-527-9600 <br /> Mailing Address 2785 MITCHELL DR BLDG 9 IST FLOOR <br /> WALNUT CREEK, CA 94598 <br /> Care of RICHARD DAY <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 20909034 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORIlil Z <br /> Account ID ARgI31-71 -'(')/) New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name VERIZON WIRELESS-PATTERSON PASS (Circle One) <br /> Account Balance as of 11/19/2013: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inane <br /> Program/Element and Description Record ID Employee ID and Name Status New Owners Delete <br /> 1926-HMBP-Unstaffed Network Location PR0510910 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513198 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> a ILLI NG and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PH SIE HD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. l also certify that all operations will be pehormed in accordance with all applicable ordinance Codes andor Standards and Slate and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Receiv <br /> RENS: Date / / Account out: Date <br /> COMMENTS: A4 1;e fq oiL­ A /" /et1 <br /> 4P <br /> patd 'Rap ptItJ <br /> �� 11 :-v <br />