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Date run 7/30/2004 11:12:44AI SAN J' QUIN COUNTY ENVIRONMENTAL HE H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/30/2W4 <br /> Record Selection Criteria: Facility ID FA0004096 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002806 New Owner ID <br /> Owner Name U S ARMY CORP OF ENGINEERS <br /> Owner DBA <br /> Owner Address 650 CAPITAL MALL <br /> SACRAMENTO, CA 95814 <br /> Home Phone 209-832-9535 <br /> Work/Business Phone 209-832-9535 <br /> Mailing Address 650 CAPITAL MALL <br /> SACRAMENTO, CA 95814 <br /> Care of U S ARMY CORP OF ENGINEERS <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004096 <br /> Facility Name DDWR TRACY <br /> Location 25700 CHRISMAN RD <br /> TRACY, CA 95376 <br /> Phone <br /> Mailing Address 8801 FOLSOM BLVD STE 200 <br /> SACRAMENTO, CA 95826 <br /> Care of JOSEPH TURNER/DAVID ZUBER <br /> Location Code 99 - UNINCORPORATED AREA APN: <br /> BOS District 005- ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003756 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name DAMES & MOORE (Circle One) <br /> Account Balance as of 7/30/2004: $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 /> 2954-NPL/SEP SITE PROJECT PRO153845 EE0000942-MARGARET LAGORIO 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 Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsq I-nt\apps\Envisions\Reports\5021.rpt <br />