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Date run 1/31/2005 8:22:27AR SAOPAQUINCOUNTY ENVIRONMENTALLTH DEPARTMENT Report#5021 <br /> Run lav Pagel <br /> Facility Information as of 1/3 2005 <br /> Record Selection Criteria: Facility ID FA0015246 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0012223 New Owner ID <br /> Owner Name JEPSEN WEBB RANCH LLC <br /> Owner DBA JEPSEN WEBB RANCH LLC <br /> Owner Address 7200 W 11TH ST <br /> TRACY, CA 95377 <br /> Home Phone 209-835-9491 <br /> Work/Business Phone Not Specified <br /> Mailing Address 7200 W 11TH ST <br /> TRACY, CA 95377 <br /> Care of KAGEHIRO, RUSSELL <br /> FACILITY FILE INFORMATION <br /> Site Mitigation Facility <br /> Facility ID FA0015246 <br /> Facility Nam <br /> LocationlTtClTc�'�r�i"r"1:"��ani �uvvi ivv <br /> TRACY, CA 95377 7y7/ <br /> Phone l o bt/- t11A N/.GOG O kaf <br /> Mailing Address 7200 W 11TH ST <br /> TRACY, CA 95377 <br /> Care of KAGEHIRO, RUSSELL <br /> Location Code 03-TRACY APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026232 New Account ID: <br /> Mail Invoices to Mail Invoices to: Owner / Facility / Account <br /> Account Nam KEN NEE Y/JENKS CONSULTANTS (Circle One) <br /> Account Balance as of 1/ O5:�yr18 60 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0522383 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/of project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the parry 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 /> Slate 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: `$155.00= Amount Paid Date <br /> Payment Type Check Number Received! by <br /> REHS: Date / 3/ / fJ$ Account out: LDate <br /> COMMENTS: 4 fes. JI /�� <br /> 1 " v <br /> Nr�E . So <br /> \\phs-ehsql-nt\apps\envisions\reports\5021 rpt <br />