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Date run 8/25/2010 9:48:16AN SAN Jt- IUIN COUNTY ENVIRONMENTAL HEA- H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/25/21,lu <br /> Record Selection Criteria: Facility ID FA0010894 <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 OW0007460 New Owner ID <br /> Owner Name EAST BAY MUD <br /> Owner DBA EAST BAY MUNICIPAL UTILITY DIS <br /> Owner Address 1804 W MAIN ST <br /> STOCKTON, CA 95203 <br /> Home Phone Not Specified <br /> Work/Business Phone 510-287-1086 <br /> Mailing Address PO BOX 24055 MS 704 <br /> OAKLAND, CA 946231055 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010894 <br /> Facility Name EBMUD CAMANCHE POWERHOUSE <br /> Location 23900 E BUENA VISTA RD <br /> CLEMENTS, CA 95227 <br /> Phone 209-772-8200 x0 <br /> Mailing Address PO BOX 24055 MS 704 <br /> OAKLAND, CA 946231055 <br /> Care of <br /> Location Code 99 - UNINCORPORATED.A Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax °�— <br /> APN 023-001 EMail : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 209-772-8200 x0 <br /> Night Phone X0 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017894 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name EBMUD CAMANCHE POWERHOUSE (Circle One) <br /> Account Balance as of 8/25/2010: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0523967 EE0001422-ARIS CACAPIT Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOfPRO513182 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CalARP PROGRAM PR0514883 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520540 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR43R0510894 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0533031 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD 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 all 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 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Receive <br /> REHS: Date / 30 / is Account out: Date / /9 <br /> COMMENTS COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />