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Date run 5/18/2005 1:5T03Pn SAN JOt*N COUNTY ENVIRONMENTAL HEALEPARTMENT Report#5021 <br /> Run by 1273 Paget <br /> Facility Information as of 5/18/200 <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 209-8364600 <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 New Account ID: <br /> Mail Invoices to Mail Invoices to: Owner / Facility / Account <br /> Account a KLEINFELDER (Circle One) <br /> Account Balance as of <br /> (Circle One) <br /> Transfer to Acdve/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 2965-WATER QUALITY SITE PROJECT PR0516772 EE0000942-MARGARET 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 paidentified 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 andror Federal Laws. <br /> APPLICANTS SIGNATURE: Date _/ / <br /> Program Records to be TRANSFERED: $20.00= Amount Paid Date <br /> Water System to be TRANSFERED: _*$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date /_/_ Account out: Date <br /> COMMENTS: <br /> /L <br /> \\p hs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />