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Date run 9/13/2012 9:05:38AR SAN JOIN COUNTY ENVIRONMENTAL HEAq DEPARTMENT Report65021 <br /> Run by Pagel <br /> Facility Information as of 9/13/2012 <br /> Record Selection Criteria: Facility ID FA0007648 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) (Z <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002996 New Owner ID <br /> Owner Name DDRW (SHARPE) <br /> Owner DBA <br /> Owner Address 850 ROTH RD <br /> LATHROP, CA 95330 <br /> Home Phone 209-982-2093 <br /> Work/Business Phone 904-332-3318 <br /> Mailing Address 2870 GATEWAY OAKS DR STE 300 <br /> SACRAMENTO, CA 958334324 <br /> Care of URS CORP ATTN RICHARD VAN DYKE <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007648 <br /> Facility Name DDRW- SHARPIES <br /> Location 850 E ROTH RD BLDG S-108 <br /> LATHROP, CA 95330 <br /> Phone <br /> Mailing Address 850 ROTH RD <br /> LATHROP, CA 95330 <br /> Care of PETER KALUSH (ASCW-BE) <br /> Location Code 07 - LATHROP Alt Phone <br /> BOIS District 003 - BESTOLARIDES Fax <br /> APN 19802001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name R IUSFr"PET-ER <br /> Title <br /> Day Phone 209_R -2088 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0012869 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facil yAccount <br /> Account Name URS (Circle Dne) <br /> Account Balance as of 9/13/2012: $0.00 <br /> (Circle One) <br /> V Tra far to Activennactva <br /> PrograMElement and Description Record ID Employee ID and Name ozkJW� Status New D <br /> Owner? Delete <br /> 2960-RWQCB SITE PR0506824 EE0099997 -WARHhYKNOiL' Active Y N A 1 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 Merges a isociated with this facility <br /> or activity will be billed to the perry identified as the OWNER on this forth I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or ft ndards and State and'or <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Rcexi led'by <br /> REHS: Date / / Account out: Date '—L&' <br /> COMMENTS: <br />