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r t, . ^ANDY SN o6oaquin County P4[S/EI-ID % Report 15021 <br /> FACILITI' INFORMATION as of 01 /07?%—PO <br /> Make changes/corrections in RED pen or pencil <br /> OWNER FILE INFORMATTON INFOANATION CRANES (date): <br /> OWNERSHIP CHANSE ldat:): <br /> OLINER 10: 004175 Neu Owner ID: 00 <br /> Owner Name: 111M <br /> Owner OBA: _ <br /> Owner Address: 40o IPNDUSTRIAL PARK OR <br /> MANTECA , CA 963'6 .-----� <br /> Home Phone: <br /> Soc Sect / Tax IOO: <br /> Ownership Type: 01 CORPORATION <br /> tailing Address: PO 80X 2301 _Qu�!���jC✓� � PAk <br /> Care of: RONICS 7 e1fAJ <br /> PIANTECA , CA 953;56 <br /> FACILITY FILE INFORMATION! <br /> FtyTY I : 005329 <br /> facility Name: G <br /> Location: 400 INDUSTRIAL. PARE; OP <br /> MANTECA 95336 C.� <br /> Phone: 209-239-4444 (•l l.$ <br /> �l <br /> Mailing Address: a r v w lel /O <br /> Care of: <br /> MANTECA , CA 95336 <br /> Location Code: 04 APN: �� <br /> ACCOUNTS RECEIVABLE FILE INFORMATION e/ I 11l <br /> lJ <br /> ACCOUNT 10: 0005786 New Account 10: 000 <br /> Mall Invoices to: Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name: ALPVIATEC USA/ItNDY ELECTRONICS (Circle one) <br /> Account Balance as of 01/07/98 . �, 1 , 1 5 6 . 5 0 ;Circle one) <br /> Record UST(s) Transfer to Activate j Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> -------------------------------------------—— -------------------------- <br /> 2335 FARM UST t3 FACILITY PR5O2O89 3913 ACCLELLON INACTIVE 2 Y P, A I D <br /> 2231 HAZARDOUS WASTE PDR FACILITY P PRS07158 3973 MCCLELLON ACTIVE Y N A I 0 <br /> 2211 HAZ WASTE PBR FAC STATE SERVIC PR5O7159 3973 MCCtEILON ACTIVE Y N A I D <br /> 2399 UNIFIED PROGRAM FAC STATE SERV PR5O716O 3973 MCCLELLON ACTIVE Y N A I 0 <br /> ---- ------------------------------------------------- --------------------------- <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1, the undersigned owner, operator or agent of sama, acknowledge that all site and;or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> B1tLINC PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN IOAQUIM <br /> COUNTY Ordinance Codes and(or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> — ---------------------_---.--------------`----------------------------- <br /> PR Records to be TRANSFERED; z $20.00 = Amount Paid Date_/ / <br /> Water System to be TRANSFERED: x $150.00 - Amount Paid Oate ;_/ <br /> Payment Type Check t Re vd by <br /> HS or COUNTER SUPV. Date r ACCT out. Date ! UNIT/F;_ <br /> Pe G W 1 6T 11 Fr,(-C' un 'R"NN ' � [ i f 1 e5 Per <br />