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Date run 1/14/2004 10:50:59AI SAN JOA`TN COUNTY ENVIRONMENTAL MALT--DEPARTMENT Report#5021 <br /> Run by P <br /> Facility Information as of 1/14/2004--- <br /> Record Selection Criteria: Facility ID FA0010258 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0008258 Case Number: H07503 New owner ID <br /> Owner Name RAY BORGES <br /> Owner DBA TRACY DIESEL ELECTRIC <br /> Owner Address <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 yp t/L-1p <br /> Facility ID FA0010258 <br /> Facility Name TRACY DIESEL ELECTRIC 3 <br /> Location 23755 S CHRISMAN RD <br /> TRACY, CA 95376 <br /> Phone 209-835-5338 <br /> Mailing Address PO BOX 1152 <br /> TRACY, CA 953781152 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN:250-140-13 <br /> BOS District 005- ORNELLAS, LEROY SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017258 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name TRACY DIESEL ELECTRIC (CirdeOne) <br /> Account Balance as of 1/14/2004: $0.00 <br /> (Circle One) <br /> Transfer to AcWe/Inactve <br /> Program/Elemam and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514257 EE0007380-STEVEN SHIH Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO512546 EE0000000-HAZ MAT SJC DES Active Y N A D <br /> 2226-CaIARP PROGRAM PR0514754 EEOOOOOOO-HAZ MAT SJC DES Active Y N A � D <br /> 2244-PACT TRANSFER RECORD-DES PRO520177 EEOOOOOOO-HAZ MAT SJC DES Active Y N A y I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0510258 EEOOOOOOO-HAZ MAT SJC DES Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowiedge that all site,amUor project specific,PHSlEHD hourly charges associated wsh 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 anclor Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / I <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date <br /> PaymentT a ecl5 umber Re 'v by <br /> REHS: / Date_�/ Z� /Q Account out: Date / / <br /> COMMEN S. <br /> � JfpllFaL( i'��. U TO d1Q y '�+-S /�r.Cv'L/7LS.S <br /> povtd 4v . 0?3737 S CAribrnA,n . <br /> SL to fid. 1 arld a- <br /> �' 4vrt eti(� l o Cam» <br /> \\Phs-ehst l nt\epps\Envisions\Reports\5021.rpt G �W V <br />