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Date run 6/29/2015 9:31:32Ah SAN 30Z 'IN COUNTY ENVIRONMENTAL HEAL�DEPARTMENT Report#5021 Run by Pagel Facility Information as of 6/29/2015 Record Selection Chtena. Facility ID FA0008044 Make changesicorrections in RED ink. INFORMATION CHANGE(date) OWNERSHIP CHANGE(date) OWNER FILE INFORMATION Number of facilities for this owner: 27 SSN/Fed Tax ID Owner ID OW0001987 New Owner ID Owner Name CHEVRON PRODUCTS COMPANY (A DIVIS, Owner DBA Owner Address 6001 BOLLINGER CANYON RD SAN RAMON, CA 94583 Home Phone 925-842-9002 Work/Business Phone 925-842-9002 Mailing Address P.O. BOX 6004, ATTN: PERMIT DESK SAN RAMON, CA 94583 Care of PERMIT DESK FACILITY FILE INFORMATION Facility ID/CERS ID FA0008044 10182331 Facility Name CHEVRON STATION#1731* Location 3355 E HAMMER LN STOCKTON, CA 95212 Phone 209-477-3699 x Mailing Address P.O. BOX 6004, ATTN: PERMIT DESK SAN RAMON, CA 94583 Care of CHEVRON STATION #208118/1731 Location Code 01 - STOCKTON Alt Phone Bos District 003 - BESTOLARIDES, STEVE Fax APN 12618007 EMail: EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0015141 NewAccount ID: Mail Invoices to Account Mail Invoices to: Owner / Facility I Account Account Name CHEVRON PRODUCTS COMPANY (A DIVISION OF (circle One) Account Balance as of 6/29/2015: $0.00 (Circle One) Thensferto Activellnadve PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delete 1921 -HMBP-Regular-Primary Location PR0520782 EE0000006-HAZA SAEED Active Y N A I D 2220-SM HW GEN<5 TONS/YR PR0518494 EE0000005-FATINAH ZAREEF Active Y N A I D 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513540 EE0000000-HAZ MAT SJC DES Inactive Y N A I D 2301 -UST STATE SURCHARGE FEE PRO508355 EE0000005-FATINAH ZAREEF Inactive Y N A I D 2361 -UST FACILITY PRO508352 EE0000005-FATINAH ZAREEF Active Y N A I D 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO508356 EE0000005-FATINAH ZAREEF Inactive Y N A I D ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533239 Inactive Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,anchor project specific,PHSrEHD hourly charges associated with this facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be pelformed in accordance with all applicable Ordinance Codes anchor Standards and State ander Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: '$25.00= Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received by EHD Staff: Date / /_ Account out: Date /_/ COMMENTS: Invoice#: