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ill l of Run by : NORA San Joaquin County PHS/EHD �v Report #5021 FACILITY INFORMATION as of 04/10/95 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - Make changes/corrections in RED pen or pencil: OWNER FILE INFORMATION Date of INFORMATION CHANGE: Date of OWNERSHIP CHANGE: OWNER ID: 002807 New Owner ID: 00 Owner Name: TRACY CITY OF Owner DBA: CITY OF TRACY AIRPORT owner Address: 560 S TRACY BLVD TRACY, CA 95376 Home Phone: 209-835-4266 Work/Business Phone: 209-835-4266 Mailing Address: 560 S TRACY BLVD care of: TRACY CITY OF TRACY, CA 95376 FACILITY FILE INFORMATION FACILITY ID: $ 3$3.7 -064 ' Facility Name: TRACY WASTEWATER TREATMENT PLN Location: 3900 HOLLY DR TRACY 95376 Phone: 209-836-1650 Mailing Address: 560 S TRACY BLVD care of: TRACY CITY OF TRACY, CA 95376 Location Code: 0 3 APN: BOS District: SIC Code: ACCOUNTS RECEIVABLE FILE INFORMATION ACCOUNT ID: 425 c73L) New Account ID: 000 Mail Invoices to: ACCOunt Mail Invoices to: Owner / Facility Account Name: CH2MHILL Account Balance as of 04/10/95 $ 418 . 00 Record UST(s) Transfer to Activate / Inactivate P/E Description ID Employee Status Linked new owner? Delete - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2381 UST LITY (BEFORE 1/84) PR232330 0142 SNAVELY ACTIVE 1 Y N AI_ D 2965 H2O QUAL SITE PROJECT PR505422 0942 LAGORIO ACTIVE Y N A I D PUBLIC WATER SYSTEM - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 facility or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date—/—/9- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Programs ate / /9- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Programs to be TRANSFERED: x = Amount Paid Date /—/9— Payment /9Payment Type Check # Recvd by REHS or COUNTER SUPV Date / /9_ ACCT out. Date UNIT/File: / /9_ O(`7 1�,