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Date run 5/27/2011 2:57:18PN SAN JO N COUNTY ENVIRONMENTAL HEA*EPARTMENT Report <br /> Run by Pagel <br /> Facility Information as of 5/27/201 <br /> Record Selection Criteria: Facility ID FA0007466 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0006172 New Owner ID <br /> Owner Name S W REALITY COMP INC <br /> Owner DBA <br /> Owner Address 6892 MARLIN CIR <br /> LA PALMA, CA 90623 <br /> Home Phone 209-836-2151 <br /> Work/Business Phone 714-521-9340 <br /> Mailing Address PO BOX 5399 <br /> BUENA PARK, CA 90622 <br /> Care of HUGHES, GEORGE <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007466 <br /> Facility Name GEORGIA PACIFIC CORP (FORMER) <br /> Location 75 W VALPICO RD <br /> TRACY, CA 95336 <br /> Phone <br /> Mailing Address 75 W VALPICO RD <br /> TRACY, CA 95336 <br /> Care of S W REALITY COMP INC <br /> Location Code 03-TRACY Alt Phone <br /> BOS District 005 - ORNELLAS, LEROY Fax <br /> APN 24613007 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name HUGHES, GEORGE <br /> Title <br /> Day Phone 714-521-9340 <br /> Night Phone Z <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0011540 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ACTON MICKELSON ENVIRONMENTAL CircteOne) <br /> Account Balance as of 5/27/2011: $0.00 <br /> (arae one) <br /> Transfer to Active/Inachre <br /> PragramlElement and Descnpljen Record ID / Employee ID and Name / Status / New Owner? Delete <br /> 2960-RWQCB SITE , PR0506509 EE0000684-MICHAEL INFURNA Actively Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: [,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project spec,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 andlor Standards and <br /> State and/or 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 Received by <br /> REHS: Date _/ _/701% Accountout: 0[ra- Date '3 / kk <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />