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Date rIF 8/2009 11:30:18AI SAN JOReport#5021IN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Pagel <br /> Run by 5200 Facility Information as of 1/28/2009 <br /> Record Selection Criteria: Facility ID FA0016516 <br /> / Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> ` \ OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION \`V SSN/Fed Tax ID <br /> Owner ID OW0002971 New Owner ID <br /> Owner Name UNION PACIFIC RALIROAD CO <br /> Owner DBA <br /> Owner Address 9451 ATKINSON ST STE 100 q6cl4Laspn C- <br /> ROSEVILLE, CA 957479711 OS2 V"LG , 7 <br /> Home Phone 916-447-7055. _-:_::.,:=-_:::_._ _.._ <br /> Work/Business Phone Not Specified <br /> Mailing Address 9451 ATKINSON ST#100 <br /> i <br /> ROSEVILLE, CA 957479711 <br /> Care of JIM LEVY <br /> FACILITY FILE INFORMATION /�J\\ Site Mitigation Facility <br /> Facility ID FA0016516 <br /> Facility Name STOCKTON RAILYARD Q <br /> Location 833 E EIGHTH ST <br /> STOCKTON, CA 95206 <br /> Phone <br /> Mailing Address 9451 ATKINSON ST#100 <br /> ROSEVILLE, CA 957479711 &e i Ut, &ft cl51114-7 <br /> ,dare of DIEL, JIM <br /> Locati6/1 Code 03 -TRACY Alt Phone <br /> BOS District 005- ORNELLAS, LEROY Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JIM LEVY <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029102 New Account ID: <br /> Mail Invoices to Account n Mail Invoices to: Owner / Facility / Account <br /> Account Name ARCADIS 1 �1.{"� (Circle One) <br /> Account Balance as of 1/28/2009: $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 PR0524607 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,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�_/ .2-�/ L9 _ <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />