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Date roe 6/21/01 3:37:53PM SAN&QUIN COUNTY PUBLIC HEALTH SES Report u: 5023 <br /> Run by Facility Information as of 6/21/01 IV Page a: 1 <br /> Record Selection Criteria: Facility ID FA0012739 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0009924 New Owner ID <br /> Owner Name: BATTAGLIA, MICHAEL <br /> Owner DBA: <br /> Owner Address: 3665 W LINNE RD <br /> TRACY, CA 95304 <br /> Home Phone: 209-835-6919 <br /> Work/Business Phone: Not Specified <br /> Mailing Address: 3665 W LINNE RD <br /> TRACY, CA 95304 <br /> Care of: MICHAEL BATTAGLIA <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0012739 <br /> Facility Name: BATTAGLIA PROPERTY <br /> Location: 2795 MACARTHUR DR <br /> TRACY, CA 95304 <br /> Phone: 209-835-6919 <br /> Mailing Address: 3665 W LINNE RD <br /> TRACY, CA 95304 <br /> Care of: MICHAEL BATTAGLIA <br /> Location Code: 03 -TRACY APN: <br /> BOIS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0021278 New Account ID: <br /> Mail Invoices to: Mail Invoices to: Owner/Facility/Account <br /> Account Name: BATTAGLIA PROPERTY (circle one) <br /> Account Balance as of 6/21/01: $0.00 <br /> (Circl ne <br /> Transfer to Act /lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? to <br /> 2950-ENVIRON ASSESS PR0516686 EE0000684-MICHAEL INFURNA Active Y N A 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 <br /> facility or activity will be billed to the party Identified as the OWNER on this form. 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 /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSF RED: '$150.00= Amount Paid Date / / <br /> Paymen Check Number Credit Card Number Re en V by / <br /> REHS: Date l l Account out: Date (Q <br /> 07 <br /> COMMENTS: <br /> \\PHS-EHSQL-NTVAPPS\Envisions\Client Access\ENVISION\REPO <br />