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Date ua 10/6/2004 2:51:23PK SAN Jr— -2UIN COUNTY ENVIRONMENTAL HE. 'H DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 10/6/2004 Page <br /> Record Selection Criteria: Facility ID FA0006902 <br /> Make changes/corrections In RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002807 New Owner ID <br /> Owner Name TRACY, CITY OF <br /> Owner DBA CITY OF TRACY WASTEWATER TREAT <br /> Owner Address 560 S TRACY BLVD <br /> TRACY, CA 95376 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-835-4266 <br /> Mailing Address 3900 HOLLY DR <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0006902 <br /> Facility Name TRACY WASTEWATER TX PLNT <br /> Location 3900 HOLLY DR <br /> TRACY, CA 95376 <br /> Phone 209-835-4266 <br /> Mailing Address 3900 HOLLY DR <br /> TRACY, CA 95376 <br /> Care of TRACY WASTEWATER TREATMENT PLN <br /> Location Code 03-TRACY APN: <br /> BOS District 005-ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0009730 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CI-112M HILL (Circle One) <br /> Account Balance as of 10/6/2004: $0.00 <br /> (Circle One) <br /> Transfer to Activeli actve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 2965-H2O QUAL SITE PROJECT PRO505422 EE0000249-MARY MEAYS Active Y N A 1 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 Me OWNER on this farm. I also certify that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date / / <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />