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Date Y /22/00 12:38:43PM SAN AQUIN COUNTY PUBLIC HEALTH SER`(S Report #: 0002 <br /> Ru DAVIS � Facility Information as,pf 6/22100 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0009693 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner to: OW0007693 Case Number: H05125 New Owner to <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 /> Facility to: FA0009693 <br /> Facility Name: PG&E STATION A SUBSTATION <br /> Location: 540 S CENTER ST <br /> STOCKTON, CA 95203 20 <br /> Phone: 209-843-5013 u <br /> Mailing Address: PO BOX 671 <br /> care of: PG&E/CLIFFSEVERSON <br /> Location Code: 01 -STOCKTON APN; 149-070-01 <br /> BOB District: 001 -GUTIERREZ, STEVE SIC code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0016693 New Account to:: <br /> Mail Invoices to: Account Mail Invoices to: Owner/Facility/Account <br /> Account Name: PG&E �� (Circle One) <br /> Account Balance as of 6/22/00: $1 . 0 Y U <br /> (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 PRO514646 EE0000000-SJC OES Active Y N 1 <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE F PRO509693 EE0000000-SJC OES Active Y N /1;� <br /> 2220-SM HW GEN<5 TONSNR PR0513983 EE000D418-KITH Active Y N OJ <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO511981 EE0000000-SJC OES Active Y N I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or went ofsame,acknowledga that aQ site,and/orprojeci <br /> specific,PHS/EHD hourly charges associated with this facility or activity will be billed to the party idemtr red as the B/LL/NGPARTYon thisform <br /> also certify that all operations will be performed in accordance with all applicable Ordinate Codes an or Standards and State and/or Federal Laws <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$0.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: •$150.00= Amount Paid Date I / <br /> Payment Type Check Number Receipt Number Received by <br /> REHS: Date / / Account out: —k-L— Date <br /> UUMMtNib <br /> 1.0.0.89.00 � �,/ <br />