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Date run 1/14/2015 11:04:02AI SAN JO*IN COUNTY ENVIRONMENTAL HEADEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1/14/2015 <br /> Record Selection Criteria: Facility ID FA0012018 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 SSN/Fed Tax ID : <br /> Owner ID OW0009317 New�Owner ID : <br /> Owner Name WESTERN GRAVEL CO INC `SStuattL.irills.14' ILGRSp QJ <br /> Owner DBA Owner Address 985 UNIVERSITY AVE 12 655 <br /> LOS GATOS, CA 95030 Las LKwS / VX91 7 <br /> Home Phone 408-354-5222 4/5— /�'Z7 S 711 <br /> Work/Business Phone Not Specified <br /> Mailing Address 985 UNIVERSITY AVE 12 <br /> LOS GATOS. CA 95030 L-as e,gicak5 AN g-7/37-- <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0012018 <br /> Facility Name QUALITY CLEANERS <br /> Location 3081 N TRACY BLVD <br /> TRACY, CA 95376 <br /> Phone 209-832-7808 <br /> Mailing Address 3081 N TRACY BLVD <br /> TRACY, CA 95376 <br /> Care of <br /> Location Code Alt Phone <br /> BOB District 005 - ELLIOTT, BOB Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CRAIG HIATT <br /> Title PROJECT ENV SPECIALIST <br /> Day Phone 925-825-4466 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0019068 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name rGo�c eccnn er�c. ��—Fj7,n fyk-a- (Circle One) <br /> Account Balance as of 1/14/2015: $0.00 <br /> (Circle One) <br /> Transferto Active/Inacive <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0515030 EE0000684-MICHAEL INFURNA Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHS[EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also minify that all operations will be performed in accordance with all applicable Ordinance Codes andfor Standards and State andlor <br /> Federal Laws. <br /> APPLICANTS 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 Receiv d y <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br />