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Date run 5/16/01 1:40:46PM SANWOUIN COUNTY PUBLIC HEALTH SEES Report #: 0002 <br /> Run by <br /> Facility Information as of 5/16/01 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0003993 <br /> Record to <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE (date) <br /> Owner to: OW0002941 New Owner ID <br /> Owner Name; DITZ BROS INC <br /> Owner DBA; MANTECA INDUSTRIAL PARK <br /> Owner Address; 170 PIONEERS RD <br /> WATSONVILLE, CA 95076- <br /> Home Phone: 408-728-1760 <br /> Work/Bussness Phone: 408-728-1760 <br /> Mailing Address: 170 PIONEERS RD <br /> WATSONVILLE, CA 95076- <br /> Care of: JOE DITZ <br /> FACILITY FILE INFORMATION <br /> Faculty ID: FA0003993 <br /> Facility Name: MANTECA INDUSTRIAL PARK <br /> Location: 575 INDUSTRIAL PARK DR <br /> MANTECA, CA 95336 <br /> Phone: 408-728-1760 <br /> Mailing Address: 170 PIONEERS RD <br /> WATSONVILLE, CA 95076- <br /> Care of: JOE DITZ <br /> Location Code: 99- UNINCORPORATED AREA APN; 221-19-572 <br /> BOS District: 005- BEDFORD, LYNN SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account to: AR0003620 New Account to:: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: MANTECA INDUSTRIAL PARK (Circle One) <br /> Account Balance as of 5/16/01: $0.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PR0009180 EE0000684-INFURNA A 've Y N A DD <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific, <br /> PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all <br /> operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System TR NSFERED: •$150.00= Amount Paid Date <br /> Payment T e Check Number T Receipt Number----------- <br /> Received by <br /> RENS: Date al 7W7-lO / 0/ Account out: tl �Date 21 <br /> 1.0.0.89.00 <br />