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Date run 5/16/01 1:41:35PM SM&QUIN COUNTY PUBLIC HEALTH SEF ES Report #: 0002 <br /> Run by Facility Information as of 5/16/01 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0004005 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0002947 New Owner ID <br /> Owner Name: MARK III ENGINEER CONTR GROUP <br /> Owner DBA• <br /> Owner Address: 5101 FLORIN-PERKINS RD <br /> SACRAMENTO, CA 95826- <br /> Home Phone: Not Specified <br /> Work/Bussness Phone: Not Specified <br /> Mailing Address: 5101 FLORIN-PERKINS RD <br /> SACRAMENTO, CA 95826- <br /> Care of: OK& B/GREG SHUBERT <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0004005 <br /> Facility Name: STONEBRIDGE INDUSTRIAL PK 9&10 <br /> Location: 1380 N MACARTHUR DR <br /> TRACY, CA 95376 <br /> Phone• <br /> Mailing Address: 2444 MAIN ST#215 <br /> FRESNO, CA 93721-2734 <br /> Care of: GEOMATRIX CONSULTANTS/JEFFERSO <br /> Location Code: 03 -TRACY APN; 250-020-52 <br /> Bos District: 005- BEDFORD, LYNN SIC code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0003635 New Account ID:: <br /> Mail Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: STONEBRIDGE INDUSTRIAL PK 9&10 (Circle One) <br /> Account Balance as of 5/16/01: $0.00 <br /> (Circle One) <br /> LIST(s) Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Sta s Linked New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PR0009230 EE0000684-INFURNA Acte Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,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 to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Typ Check Number Receipt Number Received by <br /> REHS: Date Account out: Date 01,41 <br /> 1.0.0.89.00 <br />