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Run by : LAURIEB Sa__ Joaquin County PHS/EHD Report #5021 FACILITY INFORMATION as of 05/28/96 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - / I,� Make changes/corrections in RED pen or pencil: OWNER FILE INFORMATION yn ��(/ /j,2� INFORMATION CHANGE (date): O(„ I 5 / "6' OWNERSHIP CHANGE (date): OWNER ID: 005798 N New Owner ID: 00 Owner Name: MOUNTAIN VIEW TOWNHOMES Owner DBA: owner Address: 2125 19TH STREET SACRAMENTO, CA 95818 Home Phone: Work/Business Phone: Mailing Address: 2125 19TH STREET Care of: SACRAMENTO, CA 95818 FACILITY FILE INFORMATION FACILITY ID: 007056 Facility Name: OLD VALLEY MILE POST Location: 413 MT DIABLO ` TRACY 95236 ln"q` �Yr,V i a k S bi l I i 11� �re18 S ; Phone: P D . 6DY 3J4q o i 4 SaCrd.rnerr�v, CFt- a s$3�—9D i�- Mailing Address: 4000 EXECUTIVE PARKWAY Care of: SAN RAMON, CA 94583-0959 Al Location Code: 03 APN: /lC� /�) IA BOS District: SIC Code: rQ - �IS }Q1�$l�T ACCOUNTS RECEIVABLE FILE INFORMATION\ Lk)- Slay-a, Mme, St'e 09 ACCOUNT ID: 0010185 ` New Account ID: 000 Mail Invoices to: Account ail Invoices to: Owner / Facility / Account Account Name: EMCON (Circle one) Account Balance as of 05/28/96 : $390 . 00 (Circle one) Record UST(s) Transfer to Activate / Inactivate P/E Description ID Employee Status Linked new owner? Delete - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2960 RWQCB CLEAN UP SITE PR505861 0942 LAGORIO ACTIVE Y N A I D - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PR Records to be TRANSFERED: x $20.00 = Amount Paid Date Water System to be TRANSFERED: x $150.00 = Amount Paid Date—/—/ Payment Type Check # Recvd by RENS or COUNTER SUPV:` 2 Date/a / ACCT out Date 7 -p UNIT/File: / /