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Date mn 2/6/2013 9:28:48AM SAN JO` OIN COUNTY ENVIRONMENTAL HEA,' DEPARTMENT Report 115021 <br /> Run by Y Pagel <br /> Facility Information as of 2/6/2013 <br /> Recortl Selection Criteria: Facility ID FA0007700 <br /> Make changes/corrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0004814 New Owner ID <br /> Owner Name PACIFIC GAS & ELECTRIC COMPANY <br /> Owner DBA <br /> Owner Address 77 BEALE ST <br /> SAN FRANCISCO, CA 94106 <br /> Home Phone 209-942-1566 <br /> Work/Business Phone 925-974-4231 <br /> Mailing Address 375N WIGET LN SUITE 200 <br /> WALNUT CREEK, CA 94598 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007700 <br /> Facility Name PG&E CO/LATHROP DEHYDRATOR J <br /> Location 5441 W UNDINE RD <br /> STOCKTON, CA 95206 <br /> Phone 209-942-1566 <br /> Mailing Address 375 N WIGET LN STE 200 <br /> WALNUT CREEK, CA 94598 <br /> Care of JANET 0 LIVER-ENVI RON MENTAL <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 003 - BESTOLARIDES Fax <br /> APN 19105021 Eli <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0013297 New Account ID: : <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name PG&E CO/LATHROP DEHYDRATOR (Circle One) <br /> Account Balance as of 2/6/2013: $0.00 <br /> (Circle One) <br /> Transfer to Activernadve <br /> P MElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1926 HMBP-Unstaffed Network Location PRO511961 EE0002474-MICHAEL PARISSI Active Y N A 0D <br /> -GEN 50,250 TONS PERMIT PRO507061 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0507062 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor priced specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form l also certfty that ell operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ander <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date I / <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment Type <br /> n- ��'. Check Number Receive <br /> REHS: �' — Date 2— / 0 1 Account out: Date 'Z / <br /> COMMENTS: <br />