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Date run 3/31/2006 4:41:40PR SAN JOA^UIN CQUNTY ENVIRONMENTAL HEALTM DEPARTMENT Reporl#5021 <br /> Run by Pagel <br /> Pagel <br /> o Facility Information as of 3/31/20bse' L <br /> Record Selection Cntena: Facility ID FA0010825 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION eft <br /> Owner 1D OW0008822 Case Number: H08817 New Owner ID <br /> Owner Name VINTAGE PETROLEUM LLC <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 916-661-3966 <br /> Mailing Address PO BOX 459 <br /> WOODLAND, CA 95776 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010825 <br /> Facility Name VINTAGE PETROLEUM LLC <br /> Location 2147 W BOWMAN RD <br /> STOCKTON, CA 95206 <br /> Phone 707-374-6428 <br /> Mailing Address PQZQX&,09 <br /> R {�r�r\'.Sov� Tx '150D1 - 15 b5 <br /> Care of VINTAGE PETROLEUM LLC <br /> Location Code 99- UNINCORPORATED AREA APN 191-140-01 <br /> BOS District 003-MOW, VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017825 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner I Facility I Account <br /> Account Name VINTAGE PETROLEUM LLC (Circe One) <br /> Account Balance as of 3/31/2006: $0.00 <br /> (Circe One) <br /> Transferto Active/Inadve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner'! Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO517955 EE0000753-WILLIE NG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO513113 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPR0510825 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknovAedge that all site,arW/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as fire OWNER on this form. I also candy that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State andlor Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: _*$20.00=_ Amount Paid Date / I <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Recei d by <br /> REHS: Date / / Account out: /S Date <br /> COMMENTS: <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />