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Date run 10/13/2003 2:30:52PSAN JOAW COUNTY ENVIRONMENTAL HEAD DEPARTMENT Report z5021 <br /> Run by ` Pagel <br /> Facility Information as of 10/13/20 3 <br /> Record Selection Criteria: Facility ID FA0013387 <br /> /Make changes/corrections in RED ink or pencil. <br /> INFORMATION CH E(date) <br /> OWNERS HANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0010522 New eriD : <br /> Owner Name KIEWIT PACIFIC CO <br /> Owner DBA KIEWIT PACIFIC CO <br /> Owner Address 5000 MARSH DR <br /> CONCORD, CA 94520 <br /> ---�t <br /> Home Phone Not Specified <br /> Work/Business Phone 925-686-3030 <br /> Mailing Address 5000 MARSH DR <br /> CONCORD, CA 94520 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013387 l <br /> Facility Name KIEWIT PACIFIC CO v/ W <br /> Location 26800 S KASSON RD <br /> TRACY, CA 95304Qyv <br /> Phone 925-686-3030 V <br /> Mailing Address 5000 MARSH DR <br /> CONCORD, CA 94520 <br /> Care of <br /> Location Code APN:239-230-07 <br /> BOB District 005-ORNELLAS, LEROY SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022306 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name KIEWIT PACIFIC CO (Circle One) <br /> Account Balance as of 10/13/2003: $731.00 <br /> (Circle One) <br /> Transfer to Active/Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSNR PRO517378 EE0007380-STEVEN SHIH Active Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO517865 EE0000000-HAZ MAT SJC OES Active Y N A D <br /> 2244-PACT TRANSFER RECORD-DES PRO521142 EE0000000-HAZ MAT SJC DES Active Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPRO517866 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project speck,PHS/EHD hourly charges associated 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 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: '$155.00= Amount Paid Date / / <br /> Payment Type Check Number Received If <br /> REFS: Date / / Account out: _( Date <br /> COMMENTS: <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />