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Date run 11/6/2002 1:33:23PR SAN J02' IN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report x5021 <br /> Run by \/ <br /> Facility Information as of 11/6/200 Pagel <br /> Record Selection Criteria: Facility ID FA0010825 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0008825 Case Number: H08820 New Owner ID <br /> Owner Name VINTAGE PETROLEUM INC <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/BusinessPhone 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 INC <br /> Location 2147 W BOWMAN RD <br /> STOCKTON, CA 95206 70 <br /> Phone 707-374-6428 <br /> Mailing Address 69 RIVER{{E) r- o. eDox a C1 <br /> Rle VIS A; r-A 95776 lU V16-11A CA. q'15 -11 — 1230 <br /> Care of VINTAGE PETROLEUM INC <br /> Location Code 99 - UNINCORPORATED AREA APN:191-140-01 <br /> BOB District 003 - MOW, VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017825 New Account ID: : <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name VINTAGE PETROLEUM INC (CifcleOne) <br /> Account Balance as of 11/6/2002: $0.00 <br /> (Circle One) <br /> Transfer to Active/lnactve <br /> PmgramiElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0517955 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO513113 EE000o000-HAZ MAT SJC DES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPRO510825 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned ovmer,operator or agent of same,acknowledge that all site,andlor project specific,PHS/EHD hourly charges associated with this <br /> faclity,or activity will be tilled to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinate codes andror Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Type Check Number Rece' by <br /> REHS: Date / /_ Account out: Date t <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />