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Run by NORA San Joaquin County PHS / EHD <br /> Report # 5021 FACILITY INFORMATION as of 04 / 10 / 95 <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Make changes/corrections in RED pen or pencil : <br /> OWNER FILE INFORMATION Date of INFORMATION CHANGE : <br /> Date of OWNERSHIP CHANGE : <br /> OWNER ID : 002807 New Owner ID. : OO <br /> Owner Name : TRACY CITY OF <br /> owner DBA : CITY OF TRACY AIRPORT <br /> Owner Address : 560 S TRACY BLVD <br /> TRACY , CA 95376 <br /> Home Phone : 209 - 835 - 4266 <br /> j work/Business Phone : 209 - 835 - 4266 <br /> Mailing Address : 560 S TRACY BLVD <br /> care of : TRACY CITY OF <br /> TRACY , CA 95376 <br /> FACILITY FILE INFORMATI`ON�i <br /> FACILITY ID : $$3 9— <br /> '83 � 06LO C10 - <br /> Facility Name : TRACY WASTEWATER TREATMENT PLN <br /> Location : 3900 HOLLY DR <br /> TRACY 95376 - <br /> Phone : 209 - 836 - 1650 <br /> Mailing Address : 560 S TRACY BLVD <br /> care of : TRACY CITY OF <br /> TRACY , CA 95376 <br /> Location Code : 0 3 APN : <br /> BOS District : SIC Code : t <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> q� 1 <br /> ACCOUNT 1D : 425 l (J 3L New Account ID : 000 <br /> -Mail Invoices to : Account Mail Invoices to : Owner / Facility <br /> Account Name : CH2MHILL <br /> Account Balance as of 04 / 10 / 95 $ 418 . 00 <br /> Record UST ( s ) Transfer to Activate / Inactivates <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> 2381 UST FACILITY ( BEFORE 1 /84 ) PR232330 0142 SNAVELY ACTIVE 1 Y N A I D i <br /> 2965 H2O QUAL SITE PROJECT PR505422 0942 LAGORIO ACTIVE Y N A I D ; <br /> � PUBLIC WATER SYSTEM _ E <br />'? BILLING and COMPLIANCE ACKNOWLEDGEMENT : I , the undersigned owner , operator or agentof same, acknow Ledge that all site and/or <br /> project specific PHS/EHD hour Ly charges associated with this facility or activity will be biLLed to the party identified as the <br /> BILLING PARTY on this form . I also certify that aLl operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws . <br /> APPLICANT ' S SIGNATURE : Date_/ / 9_ <br /> a - - - - - - - - - - - - - - - - - _ _ _ . . . . . . . . . . . . . _ _ _ _ _ _ - - - - - - _ _ _ . . . . . . . . . . _ . . . . . . . <br /> Programs to be TRANSFERED : x - Amount Paid Date / /9 <br /> Payment Type Check # Recvd by - <br /> RENS or COUNTER SUPV : Date_/_/ 9_ ACCT out : Date UNIT/Fi Le :_/_/ 9_ <br /> r <br /> 01 <br />