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Daterun 1/14/2015 11:04:02AI SAN JOIN COUNTY ENVIRONMENTAL HEAq DEPARTMENT <br /> Run by w Report#5021 <br /> Facility Information as of 1/14/2015 Pagel <br /> Record selection Criteria: FacilityID FA0012018 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 <br /> SSN/Fed lax ID <br /> Owner ID OW0009317 New Owner ID <br /> Owner Name WESTERN GRAVEL CO INC <br /> Owner DBA �f uµp-tLj�k i ILu6P rQ <br /> Owner Address 985 UNIVERSITY AVE 12 0055 <br /> LOS GATOS, CA 95030 (-Clis ygj±a 5 <br /> Home Phone 408-354-5222 *S- 07 :S 711 <br /> Work/Business Phone Not Specified <br /> Mailing Address 985 UNIVERSITY AVE 12 ,i k 37�SS <br /> LOS GATOS, CA 950305 ecl f�c1/3 <br /> Care of t' �L !L <br /> FACILITY FILE INFORMATION <br /> Facility ID/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 /> BOS 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 Names Crp F2 ASS0Q.A TTs.8 :Pc-P- -im–w-5L. (Circle One) <br /> Account Balance as of 1/14/2015: $0.00 Ur <br /> (Circle One) <br /> Program/Element and Description Record ID Employee ID and Name Transferto Active/Inactve <br /> Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PRO515030 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,andfor 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 certify that all operations will be performed in accordance with all applicable ordnance Codes anNor Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S 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 Recelv y <br /> RENS: Date_/ /_ Accountout: Date <br /> COMMENTS: <br />