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Daterun 6122/2009 <br /> n6122!2009 2:02:06PR SAN JG�UIN COUNTY ENVIRONMENTAL HEA�I DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/22/2009 <br /> Record Selection Criteria. Facility 0 FA0000107 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) 6? ' 22 0q <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN 1 Fed Tax ID <br /> Owner ID OW0000091 New Owner ID <br /> Owner Name MAN I, SUBAR <br /> Owner DBA DE VILLE APARTMENTS (ZC-IGH Gfl»P 1�1�27f�1�I.(Tl <br /> Owner Address 7501 S EL DORADO ST <br /> FRENCH CAMP, CA 95231 <br /> Home Phone 209-9$3-0458 <br /> Work/Business Phone 209430-1341 <br /> Mailing Address PO BOX 960 <br /> FRENCH CAMP, CA 95231 <br /> Care of MANI INVESTMENT <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000107 <br /> Facility Name DE VILLE APARTMENTS -tar <br /> Location 7501 S EL DORADO ST <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-983-0458 <br /> Mailing Address 37 HOSPITAL RD <br /> FRENCH CAMP, CA 95231 <br /> Care of MANI INVESTMENT <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 19316052 EMail : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MANI, SUBAR <br /> Title <br /> Day Phone 510-792-2377 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account lD AR0000106 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name DE VILLE APARTMENTS (Circle One) <br /> Account Balance as of 6/22/2009. $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 4242-WASTE WATER TX PLANT PR0420069 EE0004045-TED TASIOPOULOS Active Y N A I D <br /> BILLING 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 identified as the OWNER on this form, I 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 / 1 <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date / ! <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date ! 1 <br /> Payment Type Check Number Received by <br /> REHS: Date 0(9I 'L L I 0� Account out: Date I�l <br /> COMMENTS: <br /> lleh-envlenvisionlreports15021,rpt <br />