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Date run 706/01 10:12:43AM SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Report a: 5023 <br /> Run by Facility Information as of 7/18/01 Page x: 1 <br /> Record Selection Criteria: Facility ID FA0013309 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0010450 New Owner ID <br /> Owner Name: GENERAL DYNAMICS OTS (CA) INC <br /> Owner DBA: <br /> Owner Address: 400 ESTUDILLO AVE <br /> SAN LEANDRO, CA 94577 <br /> Home Phone: 510-614-5360 <br /> Work/Business Phone: Not Specified <br /> Mailing Address: 400 ESTUDILLO AVE <br /> SAN LEANDRO, CA 94577 <br /> Care of: <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0013309 <br /> Facility Name: TRACY TEST FACILITY <br /> Location: 32727 CORRAL HOLLOW RD <br /> TRACY, CA 95376 <br /> Phone: <br /> Mailing Address: 4865 COMMERCIAL DR STE A <br /> NICEVILLE, FL 32578 <br /> Care of: <br /> Location Code: APN: <br /> BOB District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0022111 New Account ID: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: TRACY TEST FACILITY (circle One) <br /> Account Balance as of 7/18/01: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Pr /Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2954- PUSEP SITE PROJECT PR0517291 EE0000997-HARLIN KNOLL Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ancuor 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: '$150.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: .mate � /12 / Account out: Date <br /> COMMENTS: <br /> \\PHS-EHSOL-NTIAPPS\Envisions\Client Access\EN SION\REPO <br />