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Ate run ,10/g/2014 11:16:27AI SAN JOOIN COUNTY ENVIRONMENTAL HEAD DEPARTMENT Report#5021 <br /> Run by 1273 Pagel <br /> Facility Information as of 10/9/2014 <br /> Record Selection Criteria: Facility to FA0022539 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID : <br /> Owner ID OW0020086 New Owner ID <br /> Owner Name Costco Wholesale Corporation <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 425-313-8100 <br /> Mailing Address 999 Lake Drive <br /> Issaquah, WA 98027 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0022539 10584298 <br /> Facility Name Costco Depot#725 <br /> Location 25149 S SCHULTE RD <br /> Tracy, CA 95377 <br /> Phone 209-221-8400 x <br /> Mailing Address P.O. Box 35005 <br /> Seattle, WA 98124-3405 <br /> Care of licensing <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 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 AR0041231 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name Costco Depot#725 (Circle One) <br /> Account Balance as of 10/9/2014: $0.00 <br /> (Circle One) <br /> Transferto ActiveBnadve <br /> ProgrsrNElement and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO539433 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO539432 EE0002646-THUY TRAN Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acW,owledge that all site,andror projed specific,PHSrEHD hourly charges associated with Nis facility <br /> or activity will be billed to the party identified asths OWNER W MIS TOM. Ialso certify that all operations will be eA rmep a di naomrdancewithallapplicable Ordin ce Cod and tandards and Stale or <br /> Federal Laws. A"-Z� IJ�(J /{VII/,r-r a ,p \ P— <br /> APPLICANTS SIGNATURE: Date _/_/ <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date / I <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Receiv <br /> RENS: Date J? Account out: Date <br /> COMMENTS: <br />