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Date run : 3/23/01 3:58:03PM SAVOAQUIN COUNTY PUBLIC HEALTH SEfPCES Report #: 0002 <br /> Run by MLAGORIO Facility Information as of 3/23/01 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0012793 <br /> Record ID <br /> Make changes/corrections in RED ink or_Renct. <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/Bussness 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 <br /> Location: 17950 VIA NICOLO <br /> TRACY, CA 95376 <br /> Phone: <br /> Mailing Address: 17950 VIA NICOLO <br /> TRACY, CA 95376- <br /> Careof: 62r" 1 <br /> Location Code: AP N: <br /> I District: IC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION � Plea5 r jam,. �� <br /> Account ID: AR0021419 New Account ID:- Ici i <br /> Mail Invoices to: Account Mail Invoices to: Owner/ cility ccount <br /> Account Name: KLEINFELDER ne) <br /> Account Balance as of 3/23/01: $-261.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PRO516772 EE0000942-LAGORIO Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agentof same,acknowledge that all site,and/or <br /> 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 <br /> form. 1 also certify thatall operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal <br /> Laws. <br /> APPLICANT'S SIGNATURE: Date / I <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Type Check Number Receipt Number��Received by <br /> REHS: Date /�/ 01 Account out: 1.45 Date U3 /—ON /LL— <br /> 1.0.0.89.00 <br />