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Report #: 0002 <br /> Date run : 6/22/00 12:52:10PM SAN AQUIN COUNTY PUBLIC HEALTH SEF"..,.ES Page #: 1 <br /> Run by- : VDAVIS " Facility Information as of 6122100 <br /> Record Selection Criteria: Facility ID FA0009680 <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 ID: OW0007680 Case Number: H05111 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 /> Facility : <br /> Facility NameePG&E: PG&E MANANTECA SUBSTATION <br /> Location: 246 ELM AVE <br /> MANTECA, CA 95336 20 P �bL7LLCr � 1 LJOrJ <br /> Phone: 209-843-5013 <br /> Mailing Address: PO BOX 671 <br /> Care of: PG&E/CLIFF SEVERSON <br /> Location Code: APN; 217-200-01 <br /> BOS District. SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0016680 New Account ID:: <br /> Mail Invoices to: Account Mail Invoices to: Owner/ Facility/Account <br /> Account Name: PG&E // .p�w5 1 (Circle One) <br /> Account Balance as of 6/22/00: $100,86 <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 PRO514636 EE0000000-SJC OES Active Y N I <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE F PR0509680 EE0000000-SJC OES Active Y N I <br /> 2220-SM HW GEN<5 TONS/YR PR0513972 EE0007289-YOUNGBLOOD Active Y N cl D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO511968 EE0000000-SJC OES Active Y N I <br /> BILLING and COMPLIANCE A CKNO WLEDGEMENT.• 1.the undersignedowner,operator or agento-same,acknowledgethat allshe,and/orproject <br /> specific,PHS/EHD hourly charges associated with this facility or activity will be billed to the party identl red as the BILLING PARTY on thisform. I <br /> also certify that all operations will be performed in accordance with all applicable Ordina ce Codes an or Standards and State and/or Federal Laws <br /> APPLICANT'S SIGNATURE: Date <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 Received by <br /> REHS: Date / / Account out: V*D Date 6 / --Z/ O <br /> 1.0.0.89.00 v y <br />