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Date run 8120/2008 9:32:32AN SAN J( f_UIN COUNTY ENVIRONMENTAL HE, z H DEPARTMENT Report#5021 <br /> Run by N.00 Pagel <br /> Facility Information as of 8/20/2008 <br /> Record Selection criteria: Facility ID FA0019059 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN 1 Fed Tax ID <br /> Owner ID OW0015685 New Owner ID <br /> Owner Name CA DEPT OF FORESTRY <br /> Owner DBA <br /> Owner Address 16502 SCHULTE RD - <br /> TRACY, CA 953779700 <br /> Home Phone 209-835-8833 <br /> Work/Business Phone Not Specified <br /> Mailing Address 16502 SCHULTE RD <br /> TRACY, CA 953779700 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019059 <br /> Facility Name CAL FIRE <br /> Location 16502 SCHULTE RD <br /> TRACY, CA 953779700 <br /> Phone 209-835-8833 <br /> Mailing Address 16502 SCHULTE RD <br /> TRACY, CA 953779700 <br /> Care of CA DEPT OF FORESTRY <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 005 - ORNELLAS, LEROY Fax <br /> APN 20911039 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 AR0033918 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility / Account <br /> Account Name CAL FIRE (CircteOne) <br /> Account Balance as of 8120/2008: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 28 -AST FAC >/=1,320-<10 K GAL CUMULATI1PR0528154 EE0000001 -LINDA TURKATTE Inactive Y N A I D <br /> BIL <br /> LI <br /> and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that afl site,andlor project specific,PHSIEHD hourly charges associated with this <br /> facil or activity will be bil$ed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State ndlor Federal Laws <br /> Z2 �JO <br /> APPLICANT'S SIGNATURE: Date 1 I <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date 1 1 <br /> Payment Type Check Number a Receiv d <br /> RENS: Date _. _I 1 0 Account out: Date 1 o Q� <br /> COMMENTS: <br /> 11phs-ehsgl-ntlappslenvisionslreports15021.rpt <br />