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Date run 1/24/2008 10.-43:35AA <br /> Run by SAN XJ COUNTY ENVIRONMENTAL HE/ <br /> �I DEPARTMENT Repoli M21Facility Information as of 1/24/2008 <br /> Record Selection Criteria: Paget <br /> Facility lO FA0018043 <br /> Make changes/corrections in RED ink or pencil. <br /> • • • t INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION �s �: �" f OWNERSHIP CHANGE(date) <br /> Owner ID OW 0014817 <br /> Owner Name WASTE MANAGEMENT New Owner ID <br /> Owner DBA WASTE MANAGEMENT <br /> Owner Address 8761 YOUNGER CREEK DR <br /> SACRAMENTO, CA 95828 <br /> Home Phone 916-379-2601 <br /> Work/Business Phone Not Specified <br /> Mailing Address 8761 YOUNGER CREEK DR <br /> Care of SACRAMENTO, CA 95828 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018043 <br /> Facility Name WASTE MANAGEMENT <br /> Location EEK DR <br /> SACRAMENTO, CA 95828 <br /> Phone <br /> Mailing Address 8761 YOUNGER CREEK DR <br /> SACRAMENTO, CA 95828 <br /> Care of BRET FAULKNER, DISTRICT MGR <br /> Location Code 98- OUT OF COUNTY APN: <br /> BOS District <br /> SIC code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0031724 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name WASTE MANAGEMENT (Circle One) <br /> Account Balance as of 112412008: $0.00 <br /> T {Circle One) <br /> Transfer to <br /> Activennacive <br /> Program/EJement and Description Record ID Employee ID and Name Status Naw Owner., Delete <br /> 4244-PUMPER TRUCK "R0526649 EEOOG5366-LISA MEDINA -Active- Y N AD <br /> 4244-PUMPER TRUCK �PR0526650 EE0005366-LISA MEDINA .Active Y N A I D <br /> 4244-PUMPER TRUCK at PRO526652 EE0005366-LISA MEDINA .Active- Y N A I D <br /> 4244-PUMPER TRUCK PRO526949 EE0005366-LISA MEDINA Active Y N A 1 D <br /> 4244-PUMPER TRUCK PRO526950 EE0005366-LISA MEDINA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,a&nowledge that ail site,and/ar 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 andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 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 by p <br /> REHS: 1, Date Lilly 8L fAccount out: �_ Date 1l O <br /> COMMENTS: l <br /> AKOV— T <br /> llphs-ehsgl-ntlappslenvisionslreports15021.rpt <br />