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Date run 12/12/2012 41316F SAN JO UtNCOUNTY ENVIRONMENTAL HEA' -'DEPARTMENT Report#5021 <br /> Run by Pagel <br /> ..- Facility Information as of 12/12/2 ,,,/ <br /> Record Selection Criteria: Facility ID FA0010590 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) / Z O Zof L <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008590 New Owner ID <br /> Owner Name TECHNOLOGY DEVELOPMENT CORP <br /> Owner DBA TECHNOLOGY DEVELOPMENT CORP <br /> Owner Address 3101 WHIPPLE RD#22 <br /> UNION CITY, CA 94587 <br /> Home Phone Not Specified <br /> Work/Business Phone 510-429-1060 <br /> Mailing Address 3101 WHIPPLERD#22 <br /> UNION CITY, CA 945871223 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010590 <br /> Facility Name TECHNOLOGY DEVELOPMENT CORP <br /> Location 1444 TILLIE LEWIS DR <br /> STOCKTON, CA 952060020 <br /> Phone 209-463-5485 x0 <br /> Mailing Address 3101 WHIPPLE RD#22 <br /> UNION CITY, CA 945871223 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 16335003 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 AR0017590 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name TECHNOLOGY DEVELOPMENT CORP (Circle One) <br /> Account Balance as of 12/12/2012: $0.00 <br /> (Circle One) <br /> Transfer to Activernactve <br /> PrograMElemenl antl Description Record ID Employee ID and Name Status New OwneO Delete <br /> 21 - P-Regular-Primary Location PR0512878 EE0009817-ROBERT LOPEZ A Y N A I D <br /> 2226-CaIARP PROGRAM PRO514835 EE0000o00-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0510590 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PR0532682 Inactive 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 facility <br /> or activity will be billed to the party identified as the OWNER on thisform I also certify that all operations will be penomed in accordance with all applicable Ordinance Codes andor Standards and State ander <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date I / <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid I D54 / <br /> Payment T Check Number Rece' y _I <br /> REHS: 1�7 .— .�L gate f 12 J_/�(_2Account out: Date <br /> COMMENTS: I V R t'L 1 NL f 0- <br /> \VD 'r �•��' l-L', ��,C��fit'1.0'I �1/l S ("T�� ' U v✓ 1 � l ' V�,/ � VLS �� C-�IZt✓l <br /> 0V1 Z,0/1 Z. �1ea,s � val-� (9 2- <br />