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Date run 5/6/2008 3:36:52PM SAN ' kQUIN COUNTY ENVIRONMENTAL Hr �T TH DEPARTMENT Report#5021 <br /> Run t:, " - "` ' w ) Page <br /> Facility Information as of 5/618 <br /> Record Selection Criteria: Facility ID FA0010734 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008734 New Owner ID <br /> Owner Name VERIZON WIRELESS INC <br /> Owner DBA VERIZON WIRELESS-HAMMER LANE <br /> Owner Address 2785 MITCHELL DR BLD9 1STFL <br /> WALNUT CREEK, CA 94598 <br /> Home Phone Not Specified <br /> Work/Business Phone -92_527_9600 <br /> Mailing Address 2785 MITCHELL DR BLDG 9 1 ST FLR <br /> WALNUT CREEK, CA 94598 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010734 <br /> Facility Name VERIZON WIRELESS INC <br /> Location 1265 N ST <br /> LATHROP, CA 95330 <br /> Phone 180-318-891 <br /> Mailing Address 2785 MITCHELL DR <br /> WALNUT CREEK, CA 94598 <br /> Care of RICHARD DAY <br /> Location Code APN: <br /> BOS District 003- MOW, VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017734 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner ! Facility 1 Account <br /> Account Name VERIZON WIRELESS INC (Circle One) <br /> Account Balance as of 51612008: $0.00 <br /> (Circle One) <br /> Transfer to Activeftactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO513022 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CalARP PROGRAM PRO514W EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARiPR0510734 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that ala operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 I <br /> Program Records to be TRANSFERED: "$20.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date 1 1 <br /> Payment Type Check Number Received <br /> REHS: Date I ! Account out: Date 7 1��IQ _ <br /> COMMENTS: S <br /> 5 <br /> 32,0 <br /> . TF <br /> "phs-ehsql-ntlappslenvisionslreports15021.rpt <br />