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Dateruri ' 513012008 12:41:41PI SAN JO UIN COUNTY ENVIRONMENTAL HEA' 4 DEPARTMENT Report#5021 <br /> Run M Paget <br /> Facility Information as of 5/30/20 <br /> Record Selection Criers. Facility ID FA0012467 <br /> Make changeslcorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0009670 New Owner ID <br /> Owner Name PG&E CREDIT & RECORDS CENTER <br /> Owner DBA PG&E CREDIT& RECORDS <br /> Owner Address 8110 N LORRAINE <br /> STOCKTON, CA 95204 <br /> Home Phone Not Specified <br /> Work/Business Phone 415-973-7000 <br /> Mailing Address PO BOX K <br /> VICTOR, CA 95253 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012467 <br /> Facility Name PG&E CREDIT& RECORDS CENTER <br /> Location 8110 N LORRAINE <br /> STOCKTON, CA 95204 <br /> Phone 209-955-7200 x0 <br /> Mailing Address PO BOX K <br /> VICTOR, CA 95253 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOIS District 003- MOW, VICTOR Fax <br /> APN 09058002 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MARK KRISTOVICH <br /> Title <br /> Day Phone 209-955-7200 <br /> Night Phone 209-955-7200 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0020326 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name PG&E CREDIT& RECORDS CENTER (circle one) <br /> Account Balance as of 5/30/2008: $0.00 <br /> (circle One) <br /> Transfer to <br /> PrograrriVeent and Description Record ID Employee ID and Name Status New OwneR Delete <br /> m <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0516116 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO520907 EEOOOOOOO-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO516117 EEOOOOOOO-HAZ MAT SJC DES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owrrer,operator or agent of same,acknowledge that all she,andrur project spaUllc,PHS/EHD hourly charges associated cant die <br /> facility or activity will be billed to the party identifiied as the OWNER on this forth. I also ce that all operations win be performed In tNtll all applicable Ord Trace Codes andlor Standards and <br /> State andlor Federal Laws. <br /> ./ <br /> pig II�o�aBBs� <br /> APPLICANTS SIGNATURE: <br /> god-0 M-Dafe0�13fo� / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date I / <br /> Payment Type Check Number Reoei <br /> REHS: Date / / Account out: Date / /05k'� <br /> COMMENTS: <br /> \\phs-ehsgl-ntlapps\envisions\repoM\5021.rpt <br />