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Date run 7/26/2004 9:55:58AN SAN JJUIN COUNTY ENVIRONMENTAL HE H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/26/ <br /> Record Selection Criteria: Facility ID FA0012793 <br /> Make changes/correctionsINFORMATIC 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 <br /> Owner Address 17950 VIA NICOLO <br /> TRACY, CA 95376 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 17950 VIA NICOLO <br /> TRACY, CA 95376 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012793 <br /> Facility Name MUSCO OLIVE PRODUCTS JW-. <br /> Location 17950�VIA NICOLO LWU)0 <br /> TRACY, CA 953+685311 <br /> Phone L?�a� S�)LO-.44400 <br /> Mailing Address 17950 VIA NICOLO <br /> TRACY, CA 95376 <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 F� Mail Invoices to: Owner / Facilit\ / Account <br /> Account Name MUSCO OLIVE PRODUCTS (Circle One) <br /> Account Balance as of 7/26/2004: $0.00 <br /> (Circle One) <br /> Transfer to <br /> Activellnacb e <br /> /Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 0- WQCB CLEAN UP SITE(SLIC) PR0516772 EE0000942-MARGARET LAGORIO Active Y N A I D <br /> LI G 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 itlentifed as the OWNER on this form. also certify that all operations will be performed in accordance with all applicable Ordinate 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 TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Type heck Number Received by <br /> f <br /> facility <br /> w Ulh Date _/ _/ Account out: Date b/ 'q'( l T <br /> OMMENTS: <br /> 141k) <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />