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Date run : 6/22/00 12:27:24PM SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Report #: 0002 <br /> Run :-WAVIS Page #: 1 <br /> bid' Facility Information as of 6/22/00 <br /> Record Selection Criteria: Facility ID FA0009684 <br /> RecordlD <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> owner ID: OW0007684 Case Number: H05116 New Owner ID <br /> Owner Name: PG&E <br /> Owner DBA; <br /> Owner Address: <br /> Home Phone: Not Specified <br /> Work/Bussness Phone: 415-973-7000 <br /> Mailing Address: PO BOX 770000 <br /> Care of: <br /> FACILITY FILE INFORMATION <br /> Faculty I : <br /> Facility Name: <br /> PG&E: PG&E MORMON SUBSTATION <br /> Location; 50 S ALPINE <br /> STOC CA 95215 20 <br /> Phone: 209-843-5013-501 CA 3 <br /> Mailing Address: PO BOX 671 <br /> Care of; PG&E/CLIFF SEVERSON <br /> Location Code: APN; 103-040-30 <br /> BOS District. SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID; AR0016684 999t��yyy New Account ID:: <br /> Mall Invoices to; Account I I Mail Invoices to: Owner/ Facility/Account <br /> Account Name; PG&E ` 1/IIJmU (Circle One) <br /> Account Balance as of 6/22/00: $ . 0 <br /> 1�\- u (Circle One) <br /> UST(s) Transfer to Active/Inacty <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2226-CaiARP PROGRAM PRO514640 EEo000000-SJC OES Active y N 1 <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE F PRO509684 EEo000o00-SJC DES Active y N 1 <br /> 2220-SM HW GEN<5 TONSNR PRO513976 EE0006213-PEDRAZA Active y N 1 <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511972 EE0000000-SJC DES Active y N I <br /> BILLING and COMPLIANCEACKNOWLEDGEMENT.• Lthe undersigned owner,operator or agent o1-saw,acknowledge that all site,andarpro/jest <br /> specific,PHS/EHD hourly charges associated with this facility or activity will be billed to the part iderur/r'ed as the BILLINGPARTYon thisform. I <br /> also certify that all operations will be performed in accordance with aU applicable Ordinace Codes and/or Standards and State and/or Federal Laws <br /> APPLICANT'S SIGNATURE: Date / I <br /> Program Records to be TRANSFERED: _*$0.00=_ Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Type Check Number Receipt Number Receive/1d/yy <br /> RENS: Date / / Account out: Date <br /> 1.0.0.89.00 �/ �� <br />