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Date run 11/24/2015 3:31:41P SAN JO, IN COUNTY ENVIRONMENTAL HEA[ DEPARTMENT Report#5021 <br /> Run by -� --- Pagel <br /> Facility Information as of 11/24/2015 <br /> Record Selection Criteria. Facility ID FA0023223 <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 OW0021369 New Owner ID <br /> Owner Name Pacific Gas and Electric Company <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 415-973-7000 <br /> Mailing Address c/o Environmental 'Services, 3401 Crow Canyc <br /> San Ramon, CA 94583 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID r CERS ID FA0023223 10648387 <br /> Facility Name PG&E -Stockton Regional Office <br /> Location 3136 Boeing Way <br /> Stockton, CA 95206 <br /> Phone X <br /> Mailing Address PO Box 7640 <br /> San Francisco, CA 94120 <br /> Care of Pacific Gas and Electric Company <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0042698 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner ! Facility 1 Account <br /> Account Name PG&E - CUPA Permits (REF: Stockton Regional Cen (Circle one) <br /> Account Balance as of 11/24/2015: $0.00 <br /> (Circle One) <br /> Transfer to Activellnaatve <br /> PrograrnfElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0540602 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2831 -AST FAC >/= 1,320-<10 K GAL CUMULATIVE PRO540603 EE0001421 -STACY RIVERA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project 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 certify that all operations will be performed in accordance with all applicable Ordinance Codes andfor 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 Type Check Number Received by <br /> EHD Staff: Date ! ! Account out: Date I I /-7-5 <br /> ! f S <br /> COMMENTS' <br /> Invoice#: <br /> � ,�,�, F�r��-y ;�►>rL,�h Cis <br />