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1r <br /> Date run 2/12/2007 11:01:15AI SAN JON COUNTY ENVIRONMENTAL HEAiLDEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/12/2007 <br /> Record Selection criteria: Facility ID FA0014864 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011870 New Owner ID <br /> Owner Name TRACY, CITY OF <br /> Owner DBA BYRON RD CORRIDOR <br /> Owner Address 3800 WATT AVE#210 <br /> SACRAMENTO, CA 95821 <br /> Home Phone 925-842-3329 <br /> Work/Business Phone Not Specified <br /> Mailing Address 3800 WATT AVE#210 <br /> SACRAMENTO, CA 95821 <br /> Care of LAURA PASTOR-SAIC <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0014864 <br /> Facility Name TRACY-BYRON RD TBR <br /> Location BYRON RD <br /> TRACY, CA 95376 <br /> Phone <br /> Mailing Address 3800 WATT AVE#210 <br /> SACRAMENTO, CA 95821 <br /> b Care of LAURA PASTOR-SAIC <br /> Location Code APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025388 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CHEVRON ENVIRONMENTAL MGMT CO (Circle One) <br /> Account Balance as of 2/12/2007: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> New Owner? Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2960-RWQCB SITE PRO521880 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 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: '$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envision s\reports\5021.rpt <br />