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Date run 11/24/2015 3:31:41P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH 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 1 <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 / 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 <br />BOS District <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Alt Phone <br />Fax <br />EMail : <br />Account ID AR0042698 <br />Mail Invoices to Account Mail Invoices to: <br />Account Name PG&E - CUPA Permits (REF: Stockton Regional Cen. <br />Account Balance as of 11/24/2015: $0.00 <br />New Account ID: <br />Owner /I Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/lnactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />1921 - HMBP-Reqular-Primary Location PRO540602 EE0009817 - ROBERT LOPEZ Active Y N A I D <br />2831 -AST FAC >/= 1,320 - <10 K GAL CUMULATIVE PR0540603 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, and/or project specific, PHS/EHD hourly Fharges 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 />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />EHD Staff: <br />COMMENTS: <br />$25.00 = <br />Date <br />Date / /T <br />Amount Paid Date <br />_ Amount Paid Date <br />Received by <br />Account out: _t�6_ Date 'r - <br />Invoice <br />Invoice #: <br />