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Date run 4/23/2013 3:20:20PN SAN JO JN COUNTY ENVIRONMENTAL HEA' DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4/23/2013 <br /> Record Selection Criteria: Facility ID FA0017515 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0014356 New Owner ID <br /> Owner Name STEPHEN M ALEGRE <br /> Owner DBA STEPHEN M ALEGRE <br /> Owner Address- gq 5- - ^tEIJI <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 249157HAi 8f-N— :114 <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0017515 10,186,571 <br /> Facility Name STEPHEN M ALEGRE <br /> Location 24915 HANSEN RD <br /> TRACY, CA 95304 <br /> Phone 209-321-6819 x0 <br /> Mailing Address 24915 HANSEN <br /> TRACY, CA 95304 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 005 -ORNELLAS, LEROY Fax U Y41 <br /> APN 20912005 EMail: L� <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> — <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030397 NewC70wne�r <br /> p: <br /> Mail Invoices to Owner Mail Invoices to: / Facility / Account <br /> Account Name STEPHEN M ALEGRE (Circle One) <br /> Account Balance as of 4/23/2013: $759.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1958-HM-Farm Operations PR0525700 Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0536104 EE0002646-THUY TRAN Active Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PR0530993 EE0002646-THUY TRAN Active,Exempt Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0536097 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PR0532394 Inactive 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 facility <br /> 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 and/or Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received <br /> REHS: Date L/ L2,/_ Account out: Date / / /3 <br /> COMMENTS: <br /> rem <br />