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Daterun5/14/2008 2:57:33PK SAN, UIN COUNTY ENVIRONMENTAL HE DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/14/200 <br /> Record Selection Criteria: Facility ID FA0012306 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0000353 New Owner ID <br /> Owner Name MANTECA, CITY OF <br /> Owner DBA CITY OF MANTECA <br /> Owner Address 1001 W CENTER ST <br /> MANTECA, CA 95337 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-239-8460 <br /> Mailing Address 1001 W CENTER ST <br /> MANTECA, CA 95337 <br /> Care of IV <br /> FACILITY FILE INFORMATION O <br /> YJ <br /> Facility ID FA0012306 <br /> Facility Name MANTECA, CITY OF <br /> Location 1001 W CENTER ST <br /> MANTECA, CA 95336 <br /> Phone <br /> Mailing Address 1001 W CENTER <br /> MANTECA, CA 95336 <br /> Care of CITY OF MANTECA <br /> Location Code 04 - MANTECA Alt Phone <br /> BOS District 003- MOW, VICTOR Fax <br /> APN 21703003 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CITY OF MANTECA <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0020055 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MANTECA, CITY OF (Circle One) <br /> Account Balance as of 5/14/2008: $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 /> 2217-APPLIANCE RECYCLER PR0518337 EE0002670-MUNIAPPA NAIDU Inactive Y N A I D <br /> 2218-CRT HANDLER PR0518338 EE0002670-MUNIAPPA NAIDU tive Y N AD <br /> ABOVEGROUND TANK(SPCC) PRO515719 EE0007289-ALISON YOUNGBL ODlnactive Y N A I D <br /> iNeY?and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associat d 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 Stan ards 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 /��/ 0 Account out: Date / / Z <br /> COMMENTS: <br /> \\phs-ehsq I-n t\apps\envisions\reports\5021.rpt <br />