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Date run 5/27/2005 10:67:28AI SAN JUIN COUNTY ENVIRONMENTAL HE#H DEPARTMENT Report#5021 <br /> Pagel <br /> Run by Facility Information as of 5/27/2005 <br /> Record Selection Criteria: Facility ID FA0012793 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0009967 New Owner ID <br /> Owner Name STUDLEY COMPANY <br /> Owner DBA MUSCO OLIVE PRODUCTS INC <br /> Owner Address 17950 W VIA NICOLO (WEST) <br /> TRACY, CA 95377 <br /> Home Phone 209-836-4600 <br /> Work/Business Phone Not Specified <br /> Mailing Address 17950 W VIA NICOLO (WEST) <br /> TRACY, CA 95377 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012793 <br /> Facility Name MUSCO OLIVE PRODUCTS INC <br /> Location 17950 W VIA NICOLO (WEST) <br /> TRACY, CA 95377 <br /> Phone 209-836-4600 <br /> Mailing Address 17950 W VIA NICOLO (WEST) <br /> TRACY, CA 95377 <br /> Care of BEN HALL <br /> Location Code APN: <br /> BOS District 005 -ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021419 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name KLEINFELDER / (Circle One) <br /> Account Balance as of 5/27/2005: $0.00 / ( (L <br /> (/J Q 7 Circle One) <br /> J <br /> Status Transferto gctive <br /> ve <br /> Navy OwnerDelete <br /> Program/Element and Description Record ID Employee ee ID d Name <br /> 2965-WATER QUALITY SITE PROJECT PR0516772 EEO 942-MARGA LAGORIO Active 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 T NSFERED: _-$155.00= Amount Paid Date II_ <br /> Payment Tye Check Number Received by c--- <br /> REHS: _ Date / / Account out: Date & <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt • • <br />