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Date run 2/6/2002 10:37:01AM 4 <br /> Run by SAN JONwof <br /> `7IN COUNTY ENVIRONMENTAL HEAT_C"'DEPARTAIEN`I' fzeN� rrourt <br /> Facility Information as of 2/6/20tJ[ Pagel <br /> Record=Selection Facility ID FA0012574 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0009775 <br /> Owner Name CITY OF TRACY New Owner ID <br /> Owner DBA <br /> Owner Address 520 TRACY BLVD <br /> TRACY, CA 95376 <br /> Home Phone 209-831-4600 <br /> Work/Business Phone Not Specified <br /> Mailing Address 520 TRACY BLVD <br /> TRACY, CA 95376 <br /> Care of CUNHA, MANUEL <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012574 <br /> Facility Name LEWIS MANOR- MUNI MW (4) <br /> Location 902 W TWELTH ST <br /> TRACY, CA 95376 <br /> Phone <br /> Mailing Address 520 TRACY BLVD <br /> TRACY, CA 95376 <br /> Care of CITY OF TRACY- MANUEL CUNHA <br /> Location Code 03 -TRACY APN: <br /> BOS District 005- BEDFORD, LYNN SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0020734 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name LEWIS MANOR- MUNI MW (4) (Circle One) <br /> Account Balance as of 21612002: $0.00 <br /> (Circle One) <br /> Transfer to <br /> Active/lnactve <br /> Program/Element and Description Record Ip Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0516350 EE0000684-MICHAEL 1NFURNA Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project speck,PHSIEHD hourly charges associated with this <br /> faciity 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 andlor 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 TRANSFERED: '$150.00= Amount Paid Date I I <br /> Payment Type Check Number Received by <br /> RENS: Date 1 1 Account out: Date I 1 <br /> COMMENTS: <br /> 11Phs-ehsq I-ntlappslEnvisionslReports15021.rpt <br />