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Date run 12/29/2006 8:34:03,4 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/29/2006 <br /> Record Selection Criteria: Facility ID FA0018089 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0014834 New Owner ID <br /> Owner Name SUTTON, LYNN <br /> Owner DBA CGKL KAMILOS DEVELOPMENT INC <br /> Owner Address 11249 GOLD COUNTRY BLVD STE 190 <br /> GOLD RIVER, CA 95670 <br /> Home Phone 209-956-0565 <br /> Work/Business Phone Not Specified <br /> Mailing Address 11249 GOLD COUNTRY BLVD STE 190 <br /> GOLD RIVER, CA 95670 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0018089 <br /> Facility Name TEIXEIRA-SOUZA PROPERTY <br /> Location 18353 W GRANT LINE RD <br /> TRACY, CA 95304 <br /> Phone <br /> Mailing Address 18353 W GRANT LINE RD <br /> TRACY, CA 95304 <br /> Care of <br /> Location Code 99 - UNINCORPORATED AREA APN:20945014 <br /> BOS District 005- ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0031817 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name WALLACE-KUHL &ASSOCIATES INC (Circle one) <br /> Account Balance as of 12/29/2006: $-285.00 <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 PR0526717 EE0000684-MICHAEL INFURNA 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 <br /> COMMENTS: <br /> \\p h s-ehsq l-nt\apps\en visions\reports\5021.rpt <br />