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Date run 9/18/2008 8:59:21AN SAN JOAW COUNTY ENVIRONMENTAL HEALTIEL-101EPARTMENT Report#5021 <br /> Run by 0 Pagel <br /> Facility Information as of 9/18/200 <br /> Record Selection Criteria: Facility ID FA0007475 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002957 New Owner ID <br /> Owner Name PG&E & CO <br /> Owner DBA PG&E - <br /> Owner Address 375 N W IGET LN STE 200 <br /> WALNUT CREEK, CA 94598 <br /> Home Phone 209-944-1450 <br /> Work/Business Phone Not Specified <br /> Mailing Address 375 N W IGET LN STE 200 <br /> WALNUT CREEK, CA 94598 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007475 <br /> Facility Name MCMULLIN DEHYDRATOR STATION <br /> Location 26250 S AIRPORT WAY <br /> MANTECA, CA 95336 <br /> Phone <br /> Mailing Address 375 N W IGET LN STE 200 <br /> WALNUT CREEK, CA 945982412 <br /> Care of PG&E GAS SUPPLY BUSINESS UNIT <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 005- ORNELLAS, LEROY Fax <br /> APN 25703010 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name GONSALZES, LINDA <br /> Title <br /> Day Phone 925-974-4081 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0011567 _ TCGW arm �� NewAccount ID: <br /> Mail Invoices to gam— Psi,rya r�5 Mail Invoices to: Owner / Facility / Account <br /> Account Name -P@gE$Cp— 1 OO (CirdeOne) <br /> Account Balance as of 9/18/2008: $0.00 bwo ex ?b a- c1 p <br /> j� " (Gree One) <br /> Transfer to Adivellnactve <br /> ProgranvElement and Description Record ID Employee ID and Name Status New Owner' Delete <br /> 2960-RWQCB SITE PR0506525 EE0000942-MARGARET LAGORIO 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 charges associated with this <br /> 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 Ordinace Codes and/or Standards and <br /> State andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid$ 31 S-0 Date <br /> Water System to be TRANSFtE�RED: _ (� '$372.00= Amount Paid Date <br /> Payment Type �'C GheekC Number 4 '144 Received by <br /> RENS: Date / / Account out: � Date (�N / A g <br /> COMMENTS: <br /> \\phs-ehsql-nl\apps\envisions\reports\5021.rpt <br />