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EDale 11/7/2014 ;Facility <br /> 05PI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT p Re ort#5021 <br /> Facility Information as of 11/712014 Pagel <br /> election Criteria: ID FA0022656 <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 : 1 SSN/Fed Tax ID <br /> Owner ID OW0020286 New owner ID <br /> Owner Name Pacific Gas & Electric Company <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 415_973-7000 <br /> Mailing Address c/o Environmental Services, 3401 Crow Canyc <br /> San Ramon, CA 94583 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility IDf CERS ID FA0022656 10599136 <br /> Facility Name PG&E -TRACY STORAGE FACILITY <br /> Location 20500 Holly Cir <br /> Tracy, CA 95304 <br /> Phone X <br /> Mailing Address PO Box 7640 <br /> San Francisco, CA 94120 <br /> Care of Pacific Gas & Electric Company <br /> Location Code Alt Phone <br /> BOS District 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 ID AR0041474 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner I Facility i Account <br /> Account Name PG&E - CUPA Permits (REF: Tracy Storage Facility) (Circle One) <br /> Account Balance as of 1117/2014: $0.00 <br /> {Circle One) <br /> Transfer to Activellnactve <br /> PrcgraMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0539597 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. 1,the undersigned owner,,operator or agent of same,acknowledge that all site,and/or project specific,PHSrEHD hourly charges associated with this facility <br /> 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 Ordinance Codes andlor Standards and Slate and'or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE Date ! 1 <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date I I <br /> Payment Type Check Number Receiv f <br /> REHS: Date —!�! Account out: vo Date=I 1 ! <br /> COMMENTS: <br /> c1i ow'v �/Csv� �+� .l- 17 V Ar c-&4-5 . <br />