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Date run 11/5/2002 2:24:34Ph SAN JO N COUNTY ENVIRONMENTAL HEAODEPARTMENT Report#1021 <br /> Run by Pagel <br /> Facility Information as of 1115/2002 <br /> Record Selection Criteria: Facility ID FA0006532 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002738 New Owner ID <br /> Owner Name HOFFMAN, PAUL &SONS <br /> Owner DBA PAUL HOFFMAN &SONS <br /> Owner Address 26577 S BANTA RD <br /> TRACY, CA 95376 <br /> Home Phone 209 <br /> Work/Business Phone Not Specified <br /> Mailing Address 26577 S BANTA RD <br /> TRACY, CA 95376 <br /> Care of PAUL HOFFMAN &SONS <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0006532 <br /> Facility Name LYOTH LOADING STATION/CHEVRON <br /> Location 26501 S BANTA RD <br /> TRACY, CA 95376 <br /> Phone <br /> Mailing Address 4233 W SIERRA MADRE ST 209 <br /> FRESNO, CA 93722 <br /> Care of STEVE STRAIT <br /> Location Code 99- UNINCORPORATED AREA APN: <br /> BOS District 005- BEDFORD, LYNN SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0008703 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CHEVRON ENVIRONMENTAL MGMT CO (Circle One) <br /> Account Balance as of 11/5/2002: $0.00 <br /> (Circle One) <br /> Transfer to gctive/Inactve <br /> New Owner? Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0009163 EE0000942-MARGARET LAGORIO Inactive Y N A I D <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PRO505092 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all she,and/or project speck,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S 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 Received by <br /> REHS: Date / / Account out: Date I / <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />