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Date run 5/24/01 11:01:16AM SAN�QUIN COUNTY PUBLIC HEALTH SER S Report #: 0002 <br /> Run by : Facility Information as of 5/24/01 Page a: 1 <br /> Record Selection Criteria: Facility ID FA0007466 <br /> Record ID <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/Bussness Phone: 714-521-9340 <br /> Mailing Address: PO BOX 5399 <br /> BUENA PARK, CA 90623- <br /> Care of: HUGHES, GEORGE <br /> FACILITY FILE INFORMATION <br /> Facility to: FA0007466 <br /> Facility Name: GEORGIA PACIFIC CORP (FORMER) <br /> Location: 75 W VALPICO RD <br /> TRACY, CA 95336 <br /> Phone: c, <br /> Mailing Address: 75 W VALPICO RD ?U N• I j C- AIC.f Ite sty O 5 <br /> TRACY, CA 95336- Culgt nluT S <br /> care of: S W REALITY COMP INC 1 ►GKSCN <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 /> Mall In ices to: Account Mail Invoices to: Owner/Facility Account <br /> ccount Na BROWN AND CALDWELL_ (circle <br /> Account Balance as of 5/24/01: 156.60 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PR0506509 EE0000684-INFURNA Active V0, <br /> 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 specific, <br /> PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all <br /> operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> PaymentT pe Check Number Receipt Number Received by <br /> REHS: Date '5 G 7r-/ Account out: =L= Date <br /> 1.0.0.89.00 <br />