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Date run 10/12/2005 4:24:01P SAN JOWIN COUNTY ENVIRONMENTAL HEA T, DEPARTMENT Report#5021 <br /> Run by 1273 Pagel <br /> Facility Information as of 10/12/2 <br /> Record Selection Criteria: Facility ID FA0016365 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0000174 New Owner ID <br /> Owner Name PILKINGTON NORTH AMERICA INC <br /> Owner DBA PILKINGTON NORTH AMERICA INC <br /> Owner Address 811 MADISON AVE <br /> TOLEDO, OH 43695 <br /> Home Phone 209-858-6290 <br /> Work/Business Phone 209-858-6291 <br /> Mailing Address 500 E LOUISE AVE PIP <br /> LATHROP, CA 95330 <br /> Care of R45g{-R4gLSWgp <br /> FACILITY FILE INFORMATION <br /> Facility ID FAD016365 <br /> Facility Name PILKINGTON NORTH AMERICA, INC <br /> Location 500 E LOUISE AVE <br /> LATHROP, CA 95330 <br /> Phone 209-858-6290 <br /> Mailing Address 500 E LOUISE AVE r)DOX <br /> LATHROP, CA 95330 <br /> Care of -RC1GER-BISWP <br /> Location Code 07- LATHROP APN' 9812006 <br /> BOS District 003-MOW, VICTOR SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0028783 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CONDOR EARTH TECHNOLOGIES INC (Circle One) <br /> Account Balance as of 10/12/2005: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New comer? Delete <br /> 2965-WATER QUALITY SITE PROJECT PRO506293 EE0000942-MARGARET LAGORIO 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,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this fans. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Rece'v <br /> REHS: Date I /_ Account out: Date <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisio ns\reports\5021.rpt <br />