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f <br /> Date run 9/18/2006 11:38:58AI SAN JOIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Ruh by Paget <br /> Facility Information as of 9/18/20 <br /> Recond Selection Criteria: Facility ID FA0016571 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0013426 New Owner ID <br /> Owner Name CA DEPT OF CORRECTIONS <br /> Owner DBA DEUEL VOCATIONAL INSTITUTE <br /> Owner Address 23500 KASSON RD <br /> TRACY, CA 953049518 <br /> Home Phone 209-835-4141 <br /> Work/Business Phone Not Specified <br /> Mailing Address 23500 KASSON RD <br /> TRACY, CA 953049518 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016571/'� <br /> Facility Name DEUEL VOCATIONAL INSTITUTE <br /> Location 23500 KASSON RD <br /> TRACY, CA 953049518 <br /> Phone 209-835-4141 <br /> Mailing Address 23500 KASSON RD <br /> TRACY, CA 953049518 <br /> Care of CA DEPT OF CORRECTIONS <br /> Location Code 99- UNINCORPORATED AREA APN:23912001 <br /> BOS District 005-ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029225✓ NewAccount ID: <br /> Mail Invoices to Account Mail Invoices Owner / Facility / ccount <br /> Account Name C-,DA17A-A (Circle One) <br /> Account Balance as of 9/18/2006: $0.00 �m M F� A ��� J�.� -1 a— <br /> ls' (Circle One) <br /> Transfer to gctive/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner' Delete <br /> /� a2nd'c <br /> --ENVIRON ASSESS PR0524672 EE0006219-LORI DUNCAN Active Y N A I D <br /> BILLIrlG' OMPLIANCE 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 torn. 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 Received by <br /> REHS Date / / Account out: ��� Date O� W9 / 06 <br /> COMMENTS: ' n <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />