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Date run 5/14/2003 8:22:19AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 5/14/2003 Pagel <br /> Record Selection Criteria: Facility ID FA0007604 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0006277 New Owner ID <br /> Owner Name SO PACIFIC REAL EST ENTERPRISE <br /> Owner DBA PROPOSED TRACY MULTIMODAL STA <br /> Owner Address 1 MARKET PLAZA, STE 912 <br /> SAN FRANCISCO, CA 94105 <br /> Home Phone 415-541-2663 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1 MARKET PLAZA, STE 912 <br /> SAN FRANCISCO, CA 94105 <br /> Care of RON PANG MGR <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007604 <br /> Facility Name PROPOSED TRACY MULTIMODAL STA <br /> Location CENTRAL AVE <br /> TRACY, CA 95376 <br /> Phone <br /> Mailing Address 1 WINEMASTERS WAY <br /> SAN FRANCISCO, CA 94105 <br /> Care of RON PANG MGR <br /> Location Code 03 -TRACY APN:235-150-16 <br /> BOS District 005- ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0012324 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SJ REG RAIL COMMISSIO (Circle One) <br /> Account Balance as of 5/14/2003: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0506739 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: *$155.00= Amount Paid Date <br /> Payment Type Check Number Rice,ed by <br /> REHS: Date 2/�/�� Account out: <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />