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Data run 6/9/2010 2:31:06PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEP- -rII DEPARTMENT <br /> Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/9/261'T <br /> Record Selection Criteria: Facility ID FA0015131 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008258 New Owner ID <br /> Owner Name RAY BORGES <br /> Owner DBA TRACY DIESEL ELECTRIC <br /> Owner Address 23737 S CHRISMAN RD <br /> TRACY, CA 95376 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-835-5338 <br /> Mailing Address PO BOX 1152 <br /> TRACY, CA 953781152 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015131 <br /> Facility Name TRACY DIESEL ELECTRIC <br /> Location 23737 S CHRISMAN RD <br /> TRACY, CA 95376 <br /> Phone 209-835-5338 x0 <br /> Mailing Address PO BOX 1152 <br /> TRACY, CA 953781152 <br /> Care of <br /> Location Code 99- UNINCORPORATED.4 Alt Phone <br /> BOS District 005-ORNELLAS, LEROY Fax <br /> APN 250-140-13 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 AR0025956 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name RAY BORGES (Circle One) <br /> Account Balance as of 6/9/2010: $0.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owren Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO522209 EE0001421 -STACY RIVERA Active Y N AI D <br /> 2244-PACT TRANSFER RECORD-DES PR0522281 Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO534229 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site.andlor project specific,PHSIEHO hourly charges associated with this <br /> facility or activity we be baled 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 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 Dat / I <br /> Payment Type �,�Check Number Receiv <br /> REHS: lll�/y =� Date / Ld Account out: Date / / <br /> C/ O�OM,�ME�NTS�: <br /> \\eh-env\envisionVeports\5021.rpt <br />