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Date run 8/17/2005 10:46:33AI SAN JO#N COUNTY ENVIRONMENTAL HEAEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/17/200 <br /> Record Selection Criteria: Facility ID FA0016362 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0010479 New Owner lD <br /> Owner Name TRIMARK COMMUNITIES LLC <br /> Owner DBA <br /> Owner Address 3120 TRACY BLVD STE A <br /> TRACY, CA 95376 <br /> Home Phone 209-836-1560 <br /> Work/Business Phone 209-836-1759 <br /> Mailing Address 3120 TRACY BLVD STE A <br /> TRACY, CA 95376 <br /> Care of STANLEY PLOOF <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016362 <br /> Facility Name MOUNTAIN HOUSE WWTP <br /> Location 17103 W BETHANY <br /> TRACY, CA 953917301 <br /> Phone 209-836-1560 <br /> Mailing Address 3120 TRACY BLVD STE A <br /> TRACY, CA 95376 <br /> Care of <br /> Location Code 99-UNINCORPORATED AREA APIN <br /> BOS District 005-ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION !N V. <br /> Account ID AR0028771 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CONDOR EARTH TECHNOLOGIES INC (Circle One) <br /> Account Balance as of 8/17/2005: $-279.00 <br /> (Circle One) <br /> Transfer to Active/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2965-WATER QUALITY SITE PROJECT PR0524391 EE0000684-MICHAEL INFURNA Active 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 specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the parry 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 /> Stale anclor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$558.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / /_ Account out: Date <br /> COMMENTS: <br /> \\p hs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />