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r �iy. Date run 7/0/2014 9:26:33AM SAN JO'%,�IN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 Run by Pagel Facility Information as of 7/9/2014 Record Selection Criteria: Facility ID FA0019228 Make changeslcorrections in RED Ink. INFORMATION CHANGE(date) OWNERSHIP CHANGE(date) OWNER FILE INFORMATION Number of facilities for this owner: 25 SSN/Fed Tax ID Owner ID OW0015531 New Owner ID Owner Name CITY OF LATHROP Owner DBA Owner Address 390 TOWNE CENTER DR LATHROP, CA 95330 Home Phone 209-941-7382 Work/Business Phone 209-941-7200 Mailing Address 390 TOWNE CENTRE DR LATHROP, CA 95330 Care of FACILITY FILE INFORMATION J7 t.f-p �� 11 'p Facility ID I CERS ID FA0019228 10187137 Facility Name LATHROP STORM DRAIN M-2 Location LATHROP, CA 95330 Phone 209-941-7200 x Mailing Address 390 TOWNE CENTER DR LATHROP, CA 95330 Care of CITY OF LATHROP Location Code 07 - LATHROP Alt Phone BOS District 003- BESTOLARIDES Fax APN 19135004 EMail: EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name MILTON DALEY Title MAINTENANCE & OPERATIONS SUPER Day Phone 209-941-7475 Night Phone 209_992-0044 ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0034209 New Account ID: : Mail Invoices to Facility Mail Invoices to: Owner 1 Facility ! Account Account Name LATHROP STORM DRAIN M-2 (Circle One) Account Balance as of 71912014: $0.00 (Circle One) Transferto Aclivennactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1926-HMBP-Unstaffed Network Location PR0538229 EE0002474-MICHAEL PARISSI Active,l Y N A I D 2840-AST EXEMPT FAG <1,320 GAL PR0528599 EE0002646-THUY TRAN Active,l Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEH❑hourly charges associated with this 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 Ordinance Codes andror Standards and State andlor Federal Laws. APPLICANT'S SIGNATURE: Date I I Program Records to be TRANSFERED: `$25.00= Amount Paid Date 1 1 Water System to be TRANSFERED: Amount Paid D to I 1 Payment Type Check Number Recei REHS: riL��r__ Date_ l _! Account out: Date r/ IR COMMENTS: