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Date run 2/13/2017 1:58:02PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report #5021 Run by Pagel Facility Information as of 2/13/2017 Record Selection Criteria: Facility ID FA0009696 Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) OWNER FILE INFORMATION Number of facilities for this owner : 28 SSN / Fed Tax ID : Owner ID OW0002957 New Owner ID Owner Name Pacific Gas and Electric Company Owner DBA PG&E Owner Address 3401 CROW CANYON RD 176C PRO511984 SAN RAMON, CA 94583 Home Phone 925-415-6381 Work/Business Phone 415-973-7000 Mailing Address c/o Environmental Services, 3401 Crow Canyc PRO509696 San Ramon, CA 94583 Care of c/o Environmental Services FACILITY FILE INFORMATION Facility ID / CERS ID FA0009696 Facility Name PG&E THORNTON DEHYDRATOR Location 29008 N THORNTON RD THORNTON, CA 95686 Phone 209-942-5020 Mailing Address 375 N WIGET LN WALNUT CREEK, CA 94598 Care of PACIFIC GAS & ELECTRIC CO Location Code 99 - UNINCORPORATED A Alt Phone BOIS District 004 - WINN, CHARLES Fax APN 00111009 EMail: EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone (� _ ACCOUNTS RECEIVABLE FILE INFORMATION b Account ID AR0016696 Mail Invoices to Facility �1 Account Name PG&E THORNTON DEHYDRATOR Account Balance as of 2/13/2017: $3 .00 New Account ID: Mail Invoices to: Owner / Program/Element and Description Record ID Employee ID and Name Status Active/Inactve New Owner? 1921 - HMBP-Reqular-Primary Location PRO511984 EE0008709 - JAMIE LIMA Active 2220 - SM HW GEN <5 TONS/YR PRO513986 EE0000030 -AARON HANG Inactive 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FE PRO509696 EE0000000 - HAZ MAT SJC OES Inactive Facility / Account (Circle One) 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 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 andtor 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 Tye Check Number Received by EHD Staff: �� Date / / Account out: Date —'24—/ s / 12 COMMENTS: Invoice #: ��I��( IS Yip � 2(' I ►1 D�d�i (1Y1. (Circle One) Transfer to Active/Inactve New Owner? Delete Y N A I D Y N A 1 D Y N A I D 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 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 andtor 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 Tye Check Number Received by EHD Staff: �� Date / / Account out: Date —'24—/ s / 12 COMMENTS: Invoice #: ��I��( IS Yip � 2(' I ►1 D�d�i (1Y1.