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Date run 6/12/2007 8:12:51AN SAN JO"` `UIN COUNTY ENVIRONMENTAL HEA' 4.1 DEPARTMENT Report#5021 <br /> Run by 1273 '11.1d � Pagel <br /> Facility Information as of 6112120 '}'° <I <br /> Record Selection Criteria: Facility ID FA0014354 <br /> Make changes/corrections in REL?ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0011404 New Owner ID <br /> Owner Name GOWAN, CARL W <br /> Owner DBA 11TH STREET BUSINESS CENTER <br /> Owner Address 2090 MAC ARTHUR DR <br /> TRACY, CA 95376 <br /> Home Phone 209-833-7475 <br /> Work/Business Phone 209-836-2482 <br /> Mailing Address 2090 MAC ARTHUR DR a6-r <br /> TRACY, CA 95376 <br /> Care of GOWAN, CARL W <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014354 <br /> Facility Name 11TH STREET BUSINESS CENTER <br /> Location 7601 W 11TH ST <br /> TRACY, CA 95376 <br /> Phone 209-836-2482 <br /> Mailing Address 2090 S MAC ARTHUR DR <br /> TRACY, CA 95376 <br /> Care of GOWAN, CARL W <br /> Location Code 03-TRACY APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024392 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility ! Account <br /> Account Name 11 TH STREET BUSINESS CENTER (Circle One) <br /> Account Balance as of 611212007: $470.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4242-WASTE WATER TX PLANT PR0519200 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,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 bit#ed 10 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 /> 'i State and/or Federal Laws. <br /> i <br /> APPLICANT'S SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: $20.00= Amount Paid Date I I <br /> Water System to be TRANSFERED: "$372.00= Amount Paid Date ! 1 <br /> Payment Type Check Number Received <br /> RENS: Date 1 ! Account out: Date I <br /> COMMENTS: <br /> llphs-ehsgl-ntlapps%envisionslreports15021.rpt <br />