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Date run 8/2012014 2:10:28PR SAN JOIN COUNTY ENVIRONMENTAL HEA 4DEPARTMENT Report#5021 <br /> Pagel <br /> Run by <br /> Facility Information as of 8/20/2014 <br /> Record Selection Criteria: Facility ID FA0022560 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN 1 Fed Tax ID <br /> Owner ID Q11,J0020131 New Owner ID <br /> Owner Name Ameresco San Joaquin LLC <br /> Owner'DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 508-661-2200 <br /> Mailing Address 111 Speen St, Ste 410 <br /> Framingham, MA 01701 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID!CERS ID FA0022560 10509610 <br /> Facility Name Ameresco San Joaquin <br /> Location 6484 North Waverly Road <br /> Linden, CA 95236 <br /> Phone 209-825-3479 x <br /> Mailing Address 111 Speen St, Ste 410 <br /> Framingham, MA 01701 <br /> Care of Ameresco San Joaquin <br /> Location Code 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 /> New Account ID: <br /> Account ID AR0041252 : <br /> Mail invoices to Facility Mail invoices to: Owner 1 Facility 1 Account <br /> (Circle One) <br /> Account Name Ameresco San Joaquin <br /> Account Balance as of 812012014: $0.00 (Circle one) <br /> Transfer to Activellnactve <br /> Program/Element and Description <br /> Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Requiar-Primary Location PRO539460 FE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0539459 EE0001422-ARIS VELOSO Active Y N A I D <br /> 2831 -AST FAC >1=1,320-<10 K GAL CUMULATIVE PRO539461 EE0001422-ARIS VELOSO <br /> 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,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 aii operations will be performed in accordance with all applicable Ordinance Codes ancilor Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! 1 <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date 1 ! <br /> Water System to be TRANSFERED: Amount Paid Date ! 1 <br /> Payment Type — <br /> Check Number Receiv <br /> REHS: Date_ 1 _! t� Account out: date ! ! <br /> COMMENTS: <br /> om" �rACkUt" t- P-rR-v�. <br /> C <br /> �,w a Lq e-ltiiS .�,� 1AM • C��o25`v�v� <br /> H,N'. <br />