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Date run 5/18/2020 3:30:06PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/18/2020 <br /> Record Selection Criteria: Facility ID FA0025339 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0024006 New Owner ID <br /> Owner Name GLENN SPRINGS HOLDINGS <br /> Owner DBA <br /> OwnerAddress PO BOX 2148 <br /> HOUSTON, TX 77252 <br /> Work/Business Phone Not Specified <br /> Alternative Phone Not Specified <br /> Mailing Address PO BOX 2148 <br /> HOUSTON, TX 77252 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0025339 <br /> Facility Name CITY OF LATHROP RIGHT OF WAY <br /> Location 16051 TO 16407 MCKINLEY AVE <br /> LATHROP, CA 95330 <br /> Phone <br /> Mailing Address PO BOX 2148 <br /> HOUSTON, TX 77252 <br /> Care of <br /> Location Code 07 - LATHROP Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0047712 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name GEOSYNTEC CONSULTANTS INC (Circle One) <br /> Account Balance as of 5/18/2020: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB LEAD AGENCY CLEAN UP SITE PR0544578 EE0000034-NASEEM AHMED Active Y N AI D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersi ned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with t�hls facility <br /> or activity will be billed to the party identified as the OWNER on th' m. I also certify that operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: 4540= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type jChhck Number ReceiI&L:: <br /> EHD Staff: Date-/-/ Account out: Date 20 <br /> COMMENTS: <br /> Invoice#: <br />