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Date run 8/30/2005 2:20:54PN SAN JO, IN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/30/2005 <br /> Record Selection Criteria: Facility ID FA0014798 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0010479 New Owner ID <br /> Owner Name TRIMARK COMMUNITIES LLC <br /> Owner DBA <br /> Owner Address 3120 TRACY BLVD STE A <br /> TRACY, CA 95376 <br /> Home Phone 209-836-1560 <br /> Work/Business Phone 209-836-1759 <br /> Mailing Address 3120 TRACY BLVD STE A <br /> TRACY, CA 95376 <br /> Care of STANLEY PLOOF <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014798 <br /> Facility Name MOUNTAIN HOUSE NEIGHBORHOOD E <br /> Location MASCOT& MARINA BLVD <br /> TRACY, CA 95376 <br /> Phone <br /> Mailing Address 3120 TRACY BLVD <br /> TRACY, CA 95376 45PZ6b0,4 <br /> Care of STANLEY R PLOOF Z 5aw tf Z <br /> Location Code 03 -TRACY APN:209-050-08 <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR002521 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / FacilityAccount <br /> Account Name SHELL OIL PRODUCTS US (Circle One) <br /> Account Balance as of 8/30/2005: $818.40 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB SITE PR0521796 EE0000684-MICHAEL INFURNA Active V 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 NSF ED: *$558.00= Amount Paid Date <br /> Payment Type Check Number =�� <br /> -- <br /> RENS: Date / / v5 Account out: Date /R-4 /'0\f) <br /> COMMENTS: <br /> CONFIDENTIAL <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />