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Date run 10/31/2013 9:17:18A SAN Joe IN COUNTY ENVIRONMENTAL HEAIO DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 10/31/2013 Pagel <br /> Record Selection Criteria: Facility ID FA0021779 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0017930 New Owner ID <br /> Owner Name PROLOGIS CORPORATION <br /> Owner DBA FED X GROUND TRACY PROJECT <br /> Owner Address 17284 W COMMERCE WAY <br /> TRACY, CA 95377 <br /> Home Phone 209-833-5381 <br /> Work/Business Phone Not Specified <br /> Mailing Address 17284 W COMMERCE WAY <br /> TRACY, CA 95377 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility lD/CERS ID FA0021779 <br /> Facility Name FED X GROUND TRACY PROJECT <br /> Location 16101 W SCHULTE &24550 HANSEN RD <br /> TRACY, CA 95377 <br /> Phone <br /> Mailing Address 2430 CAMINO RAMON STE 122 <br /> SAN RAMON, CA 94583 <br /> Care of PHILIP MCLAUGHLIN <br /> Location Code 03 -TRACY Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN EMail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name LILY MULLINS <br /> Title <br /> Day Phone 916-863-9360 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0039592 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name VERSAR INC (Circle One) <br /> Account Balance as of 10/31/2013: $-875.00 <br /> (Circle One) <br /> Transferto Activefinactve <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PRO537774 EE0001699-JOHNNY YOAKUM 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 facility <br /> or activity will be billed to the party identified as the OWNER on this form Ialso certify that all operations will be performed in accordance with all applicable Ordinance Codes andfor standards and State and'or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br />