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Date run 7/19/2017 n 7/19/2017 9:42:32AM1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Pagel <br /> Run by <br /> Facility Information as of 7/19/2017 <br /> Record Selection Criteria: Facility ID FA0002048 <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: 8 SSN/Fed Tax ID <br /> Owner ID OW0002829 New Owner ID <br /> Owner Name TESORO SIERRA PROPERTIES LLC <br /> Owner DBA <br /> OwnerAddress 19100 RIDGEWOOD PKWY <br /> SAN ANTONIO, TX 78259 <br /> Home Phone 818-577-2663 <br /> Work/Business Phone 210-626-4673 <br /> Mailing Address 19100 RIDGEWOOD PKWY, MS: TX1-022 <br /> SAN ANTONIO, TX 78259 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0002048 10411900 <br /> Facility Name TESORO (Shell) 68221 <br /> Location 2705 COUNTRY CLUB BLVD <br /> STOCKTON, CA 95204 <br /> Phone 210-626-4673 x <br /> Mailing Address 19100 RIDGEWOOD PKWY MS: TX1-022 <br /> San Antonio, TX 78259 <br /> care of Tesoro West Coast Company LLC <br /> Location Code 01 -STOCKTON Alt Phone <br /> Bos District 003 - BESTOLARIDES, STEVE Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account lD AR0003410 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name TESORO SIERRA PROPERTIES LLC (Circle One) <br /> Account Balance as of 7/19/2017: $0.00 <br /> (Circle One) <br /> Transfer to Activellnacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO520556 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0518421 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513218 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PRO515539 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> 2361-UST FACILITY PR0231072 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PR0507290 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PRO533410 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project specific,PHSfEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also minty that all operations will be performed in accordance with all applicable Ordinance Codes andlor Standards and State anclor <br /> Federal Laws. <br /> APPLICANTS 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: Invoice f{: <br />