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Date run 7/21/2020 11:21:08Af SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/21/2020 <br /> Record Selection Criteria: Facility ID FA0006988 <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: 12 SSN/Fed Tax ID <br /> Owner ID OW0004745 New Owner ID <br /> Owner Name TRACY, CITY OF <br /> Owner DBA <br /> OwnerAddress 520 TRACY BLVD <br /> TRACY, CA 95376 <br /> Work/Business Phone Not Specified <br /> Alternative Phone 209-836-4420 <br /> Mailing Address 520 TRACY BLVD <br /> TRACY, CA 95376 <br /> Care of TRACY, CITY OF <br /> FACILITY FILE INFORMATfON Site Mitigation Facility <br /> Facility ID/CERS ID FA0006988 <br /> Facility Name ALDEN PARK CHEVRON <br /> Location 500 N SEQUOIAAVE <br /> TRACY, CA 95376 <br /> Phone <br /> Mailing Address 520 TRACY BLVD <br /> TRACY, CA 95376 <br /> Care of TRACY, CITY OF <br /> Location Code 03 -TRACY Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 23416001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CITY OF TRACY <br /> Title <br /> Day Phone 510-842-6930 <br /> Night Phone 953-76 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0009998 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ARCADIS (Circle One) <br /> Account Balance as of 7/21/2020: 1752.40 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB LEAD AGENCY CLEAN UP SITE PR0505768 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,and/or 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 Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. -�;a LJ <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 Received by <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> It '.il Ir <br /> Invoice#: <br />