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Run by : NORA SAN JOAQu'WcOUNTY PUBLIC HEALTH SERVICES 'r.✓ Report #5021 FACILITY INFORMATION as of 08/03/94 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Make changes/corrections in RED pen or pencil: OWNER FILE INFORMATION Date of INFORMATION CHANGE: / Date of OWNERSHIP CHANGE: OWNER ID: 003399 / New Owner ID:. 00 Owner Name: BERNARD V ELISSAGARAY ,rr•t �T { Owner DBA: TRACY AIRPORT CENTER Owner Address: 115 BRIA CT r G. WALNUT CREEK, CA 94596 Nome Phone: Work/Business Phone: Mailing Address: 115 BRIA CT Care of: BERNARD V ELISSAGARAY WALNUT CREEK, CA 94596 FACILITY FILE INFORMATION FACILITY ID: 004484 Facility Name: TRACY AIRPORT CENTER Location: 1660 W LINNE RD TRACY 95376 Phone: Mailing Address: 1660 W LINNE RD care of: TRACY AIRPORT CENTER TRACY, CA 95376 Location Code: 99 APN: WCLINNE11 BOS District: 99 SIC Code: ACCOUNTS RECEIVABLE FILE INFORMATION ACCOUNT ID: 0004166 New Account ID: 0 Mail Invoices to: Account Mai l Invoices to. �wner_/ Facility�� Account Name: CIVIC BANK—OF COMMERCE - Account Balance as of 081/03/94 $ 350 . 00 FILES LINKED: WATER SYSTEM FILE linked Transfer WATER program to New Owner? Y N A / I / D Record UST(s) Transfer to Activate / Inactivate P/E Description ID Employee Status Linked new owner? Delete - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date / /9 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- Programs to be 7RANSFERED: x $20.00 = Amount Paid Date —/—/9— Payment /9_Payment Type Check # Recvd by - - - - - - - - - - - - - - - - - - - - - - - - - - )- - ✓✓✓- rrr-///111-��D- - - - - - - REHS or COUNTER Sum ' Date„ / /9 ACCT out: {�V Date / /9 UNIT/File:_/_/9