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Date run 5/23/2013 1:52:06PR SAN JIN COUNTY ENVIRONMENTAL HEA*DEPARTMENT Report#5021 <br /> Run by COU Pagel <br /> Facility Information as of 5/23/2013 <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 <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 PHILIP MCLAUGHLIN <br /> Title SENIOR PROJECT MANAGER - BVNA <br /> Day Phone 925-498-6512 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0039592 NewAccount ID: <br /> Mail lnvoicesto Account Mail Invoices to: Owner / Facility / Account <br /> Account Name BUREAU VERITAS NORTH AMERICA(BVNA) (Circle One) <br /> Account Balance as of 5/23/2013: $0.00 <br /> (Circle One) <br /> Progranâś“Elemenl and Description Record ID Em I ee ID antl Name Transfer to ActiveAnactve <br /> Employ" Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PRO537774 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT 1,the undersigned owner,operator or agent of same,acknowledge that all site,ani project specific,PHSrEHD hounycharges associatedwiih this facility <br /> or activity will be billed to the party identified as the OWNER on this form l also certify that all operations will be performed in accordance with all applicable Ordinance Caries andtor Standards and State ender <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 />