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Date mn 8/15/2014 9:56:12AR SAN JUO�IN COUNTY ENVIRONMENTAL HEAON.4)EPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 8/15/2014 Paget <br /> Record selection Criteria: Facility ID FA0022517 <br /> Make changes/corrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0020044 New Owner ID <br /> Owner Name Ameresco Forward LLC <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 508-661-2200 <br /> Mailing Address 111 Speen St, Ste 410 <br /> Framingham, MA 01701 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0022517 10586578 <br /> Facility Name Ameresco Forward <br /> Location 9999 South Austin Road <br /> Manteca, CA 95336 <br /> Phone 530-892-1407 x <br /> Mailing Address 9999 South Austin Road <br /> Manteca, CA 95336 <br /> Care of Ameresco Forward LLC <br /> Location Code All Phone <br /> BOIS District Fax <br /> APN 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 AR0041197 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name Ameresco Forward (Circle One) <br /> Account Balance as of 8/15/2014: $0.00 <br /> (Circle One) <br /> Transfer toActivellnacive <br /> ProgramlElemenl and Description Record ID Employee 10 and Name Status New Ownef! Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO539397 EE0002474-MICHAEL PARISSI Active Y N A 1 D <br /> 2220-SM HW GEN<5 TONS/YR PRO539396 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PRO539398 EE0009001 -ELENA MANZO Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Ne undersigned owner,operator or agent of same,acknowledge Nat all site,amrfor project specigo,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 ander Standards and State ands <br /> Federal Laws. <br /> APPLICANTS 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 Recely y <br /> REHS: IAM Date Accountout: DateI /� <br /> COMMENTS: <br /> NCS rjo k, "t'l 't, 1�RAG.R-ArMS V\A ckiie-S . <br /> {�1u CN `> - 3L� � Ev+L '2nt"1 . �KV#o?65gb5 <br />