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Date run 12/31/2007 1:53:07P SAN X JIN COUNTY ENVIRONMENTAL HEA I DEPARTMENT Report#5021 <br /> Run by �� Pagel <br /> Facility Information as of 12/31/2007 <br /> Record Selection Criteria: Facility ID FA0006902 <br /> Make changes/corrections in RED ink or pencil. <br /> 1 L E 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 Site Mitigation Facility <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 K New Account ID: <br /> Mail Invoices to Account / Mail Invoices to: Owner I Facility Accoun <br /> Account Name CH2MHILL /X (Circle One) <br /> Account Balance as of 12/31/2007: $0.00 [1( <br /> (Circle One) <br /> Transfer to Active/Inadve <br /> Progmm/Element and Description Record ID Employee ID and a Status New Owner) Delete <br /> 2965-WATER QUALITY SITE PROJECT PRO505422 EE000 9-MAR EAYS Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or gent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. 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 /> APPLICANTS 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 Re�ce`iv/eyd by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsql-ntlapps\envisions\reports\5021.rpt <br />