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Run by : MORA San Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 07/12/95 <br /> ------------------------------------------------------------------------------- <br /> Make changes/corrections in RBD pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date): <br /> OWNERSHIP CHANGE (date): <br /> I <br /> OWNER IN 005468 New Owner ID: 00 <br />' Owner Name: WESTERN REFRIGERATION COLD STO <br /> Owner DBA: <br /> Owner Address: PO BOX 15805 <br /> LENARA, KS 66215-5805 <br /> Rome Phone: 305-593-6565 <br /> Work/Business Phone: <br /> 9 Mailing Address: 2001 NW 107TH AVE <br /> Care of: SOUTHEASTERN PUBLIC SERVICE CO <br /> MIAMI, FL 33172 <br /> FACILITY FILE INFORMATION <br /> x <br /> FACILITY ID: 006715 <br /> Facility Name: TRACY COLD STORAGE INC <br /> Location: 24500 S MACARTHUR DR <br /> TRACY 95378-0420 <br /> Phone: 209-835-4424 <br /> Mailing Address: PO BOX 420 <br /> Care of: TRACY COLD STORAGE INC <br /> TRACY, CA 95378-0420 <br /> Location Code: 03 APN: <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE . FILE INFORMATION <br /> ACCOUNT ID: 0009119 New Account ID: 000 <br /> Mail Invoices to: Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name: TRACY COLD STORAGE INC (Circle one) <br /> Account Balance as of 07/12/95 : $0 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> PIE Description ID Employee Status Linked new owner? Delete <br /> ------------------------------------------------------------------------------- <br /> 2950 ENVIRON ASSESS PR505329 0942 LAGORIO ACTIVE Y N A I D <br /> ------------------------------------------------------------------------------- <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all 6perations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> ------------------------------------------------------------------------------- <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid Date <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid Date ! / <br /> Payment Type Check I Recvd by <br /> ________ p__=______=_______________________________________ <br /> RRRS or COUNTER SUPV:.�ZDate /�/ `s ACCT out: Dated /11,!� UNITiFile: / / <br /> +w' t <br />