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.. a <br />Date run 2/27/2014 8:19:22AN SAN JC AN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 2/27/2014 <br />Record Selection Criteria: Facility ID FA0014446 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION SSN/Fed Tax ID <br />Owner ID OW0011488 New Owner ID <br />Owner Name Transmission Agency of Northern California <br />Owner DBA PIXLEY MICROWAVE COMM FACILITY <br />Owner Address 3100 ZINFANDEL DR 600 <br />RANCHO CORDOVA, CA 956706026 <br />Home Phone Not Specified <br />Work/Business Phone 916-852-1673 <br />Mailing Address 3100 Zinfandel Drive, Suite 600 <br />Rancho Cordova, CA 95670 <br />Care of WAP ADM, NATURAL RESOURCES MGR <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0014446 10,442,452 <br />Facility Name Pixley Microwave Communication Facility (CO' <br />Location Stefani Ln Off 8 Mile Road Of Stockton Lat 38 - <br />Stockton, CA 95202 <br />Phone 916-353-4416 x <br />Mailing Address 114 Parkshore Drive <br />Folsom, CA 95630 <br />Care of Western Power Administration, Sierra Nevada <br />Location Code Alt Phone <br />BOS District 003 - BESTOLARIDES Fax <br />APN EMail: <br />EMERGENCY NOTIFICATION CONTACT INFORMATION �Q�� <br />Contact Name `Y( <br />Title v <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0024526 <br />Mail Invoices to Account Mail Invoices to: <br />Account Name PIXLEY MICROWAVE <br />Account Balance as of 2/27/2014: <br />Program/Element and Description Record ID Employee ID and Name <br />1921 - HMBP-Reqular-Primary Location PR0519304 EE0008709 - JAMIE DE LA ROSA <br />2239 - REMOTE WASTE CONSOLIDATION SITE PR0538338 EE0001422 - ARIS CACAPIT <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0532629 <br />New Account ID: : <br />Owner / Facility <br />(Circle One) <br />Account <br />(Circle One) <br />Transfer to Active/Inactve <br />Status New Owner? Delete <br />Active Y N AD <br />Active Y N A I D <br />Inactivf 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, PHSIEHD hourly charges associated with this facility <br />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 Ordinance Codes and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: Date <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS: <br />nx� <br />�t+ q wrc5 <br />* $25.00 = Amount Paid Date <br />Amount Paid Date <br />Receiv y <br />Date / / Account out: Date / / <br />,Rr cAvey-N <br />c�v,soUaafirm �i <br />