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Date run 3/29/2017 1:49:03Pry SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 3/29/2017 <br />Record Selection Criteria: Facility ID FA0009696 <br />OWNER FILE INFORMATION Number of facilities for this owner : 28 <br />Owner ID <br />OW0002957 <br />Owner Name <br />Pacific Gas and Electric Company <br />Owner DBA <br />PG&E <br />OwnerAddress <br />3401 CROW CANYON RD 176C <br />Phone <br />SAN RAMON, CA 94583 <br />Home Phone <br />925-415-6381 <br />Work/Business Phone <br />415-973-7000 <br />Mailing Address <br />c/o Environmental Services, 3401 Crow Can <br />Location Code <br />San Ramon, CA 94583 <br />Care of <br />c/o Environmental Services <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0009696 <br />Facility Name <br />PG&E THORNTON DEHYDRATOR <br />Location <br />29008 N THORNTON RD <br />Day Phone <br />THORNTON, CA 95686 <br />Phone <br />209-942-5020 <br />Mailing Address <br />375 N WIGET LN <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />WALNUT CREEK, CA 94598 <br />Care of <br />PACIFIC GAS & ELECTRIC CO <br />Location Code <br />99 - UNINCORPORATED A <br />Bos District <br />004 - WINN, CHARLES <br />APN <br />00111009 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Make changestcorrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0016696 <br />New Account ID: <br />Mail Invoices to Facility Mail Invoices to: <br />Owner / <br />Facility / Account <br />Account Name PG&E THORNTON DEHYDRATOR <br />(Circle One) <br />Account Balance as of 3/29/2017: $0.00 <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name <br />Status <br />New Owner? Delete <br />1921 - HMBP-Regular-Primary Location PR0511984 EE0008709 - JAMIE LIMA <br />Active <br />Y N AD <br />q, <br />2220 - SM HW GEN <5 TONS/YR PR0513986 EE0000030 -AARON HANG <br />Inactive <br />Y N A D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F1 PRO509696 EE0000000 - HAZ MAT SJC OES <br />Inactive <br />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 <br />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: Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Ty e, Check Number Received y <br />EHD Staff: � (� _ Date 17A /�_ Account out: <br />Date <br />COMMENTS: <br />+r0h <br />1 �'!i5 �.�I "� J V pta • <br />C/Y�u� <br />Invoice #: <br />