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Date run 11/15/01 9:15:07AM SANUIN COUNTY PUBLIC HEALTH SER*S Report x: 6023 <br /> Runby Facility Information as of 11/15/01 Page u: 1 <br /> Record Selection Criteria: Facility ID FA0007466 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <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 APN: <br /> BOS District: 005- BEDFORD, LYNN SIC Code: <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 (Circle One) <br /> Account Balance as of 11/15/01: $-267.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PR0506509 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project speck,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 TRANSFERED: —*$150.00= Amount Paid Date—I—/— <br /> Payment <br /> /Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />