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Date run 8/20/2014 2:10:28PA SAN JO:-,.WJIN COUNTY ENVIRONMENTAL HEALtpi DEPARTMENT Report V5021 <br /> Run by Pagel <br /> Facility Information as of 812012014 <br /> Record Selection Criteria: Facility ID FA0022560 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN1 Fed Tax ID <br /> Owner ID Ot,/~,10020131 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 Speer! 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 /> Account ID AR0041252 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility 1 Account <br /> Account Name Ameresco San Joaquin (Circle One) <br /> Account Balance as of 812012014: $0.00 <br /> (Circle One) <br /> Transfer to Acliveflnaclve <br /> Program/Element and Description Record ID Employee to and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0539460 EE0008709-JAMIE DE!A 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 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor 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 l also certify that all operations will be performed in accordance with all applicable Ordinance Codes andlor Standards and State andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date f 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Receiv <br /> REHS: `Il _ Date /2�Zl tL_ Account out: L Date 1 l <br /> COMMENTS: <br /> C V1 Pill, <br /> FAckukA <br /> { t W _- \A-L — Vic— erCL 0'-J. <br />