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Date run 9/18/2006 11:38:58AI SAN JOil-COUNTY ENVIRONMENTAL HEAL--DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/18/2006 <br /> Record 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 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / ccount <br /> IpfAccount Name & � C.orr\�� (cirue one) <br /> Account Balance as of 9/18/2006: $0.00 Seo- 1�1 Pl 0-4k ,4wt� <br /> (Circle One) <br /> New OwTransfertomeY? Active/Inactve <br /> Program/Element and Description Record ID_ Employee ID and Name Status Delete <br /> ,2114o-ENVIRON ASSESS PRO524672 EE0006219-LORI DUNCAN Active Y N A I D <br /> BILLIra nkOMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acmawledge that all site,and/or project spec,PHS/EHO hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this farm. 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 I / <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / I Account out: Date <br /> COMMENTS: <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />