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Date run 12/6/2021 9:20:30AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 12/6/2021 <br />Record Selection Criteria: Facility ID FA0006905 <br />OWNER FILE INFORMATION Number of facilities for this owner : 1 <br />Owner ID <br />OW0005668 <br />Owner Name <br />CALIF DEPT OF CORRECTIONS <br />Owner DBA <br />DEUEL VOCATIONAL INSTITUTION <br />OwnerAddress <br />23500 KASSON RD <br />Phone <br />TRACY, CA 95304 <br />Work/Business Phone <br />Not Specified <br />Alternative Phone <br />209-830-3932 <br />Mailing Address <br />23500 KASSON RD <br />TRACY, CA 95304 <br />Care of <br />FACILITY FILE INFORMATION APN 23912001 <br />Facility ID / CERS ID <br />FA0006905 <br />Facility Name <br />DEUEL VOCATIONAL INSTITUTION <br />Location <br />23500 KASSON RD <br />TRACY, CA 95376 <br />Phone <br />916-255-0516 <br />Mailing Address <br />23500 KASSON RD <br />TRACY, CA 95304 <br />Care of <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0009744 <br />Mail Invoices to Account <br />Account Name AMEC FOSTER WHEELER' <br />Email invoice to (up to 2 emails) <br />Email permit to (up to 2 emails) <br />Account Balance as of 12/6/2021: $0.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Ie <br />2960 - RWQCB LEAD AGENCY CLEAN UP SITE PR0505626 EE0000418 - MICHAEL KITH Active Y N I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, he undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD hourly charges associated with this acility <br />or activity will be billed to the party identified as the O R on this forrp I alp certify that all opgr�tions will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br />Federal Laws. �� // <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff: <br />COMMENTS <br />I AL� Date 1 (�/21 <br />V00 <br />L./Amount Paid Date <br />Amount Paid Date <br />Receive r <br />Date / / Account out: Date /2—/ 1 <br />Invoice #: <br />