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Date run il�15/401,5 2:38:38PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 5/15/2015 <br />Record Selection Criteria: Facility ID FA0022937 <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 <br />OW0020939 New Owner ID <br />Owner Name <br />Pacific Gas and Electric Company <br />Owner DBA <br />Owner Address <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />415-973-7000 <br />Mailing Address <br />c/o Environmental Services, 3401 Crow Canyc <br />San Ramon, CA 94583 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0022937 10627111 <br />Facility Name <br />PG&E - Sutter Home Switching Station <br />Location <br />18667 N Brack Rd <br />Lodi, CA 95242 <br />Phone <br />X <br />Mailing Address <br />PO BOX 7640 <br />San Francisco, CA 94120 <br />Care of <br />Pacific Gas and Electric Company <br />Location Code <br />Alt Phone <br />BOS District <br />Fax <br />APN <br />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 AR0042062 <br />Mail Invoices to Account Mail Invoices to: <br />Account Name PG&E - CUPA Permits (REF: Sutter Home SS) <br />Account Balance as of 5/15/2015: $0.00 <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1921 - HMBP-Regular-Primary Location PR0540115 EE0008709 - JAMIE DE LA ROSA 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/or project specific, PHS/EHD 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 and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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: P11, Date / AS— / ;' Account out: Date <br />COMMENTS: Invoice D p <br />tl <br />Cie -4CJj <br />6< <t <br />