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Run by •. L'AUR`ItB San Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 04/10/97 <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> .Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date): <br /> OWNERSHIP CHANGE (date): <br /> OWNER ID: 002738 New Owner ID: 00 <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 /> Soc Sec# / Tax ID#: <br /> ownership Type: 02 INDIVIDUAL <br /> Mailing Address: 26577 S BANTA RD <br /> care of: PAUL HOFFMAN & SONS <br /> TRACY, CA 95376 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 006532 <br /> Facility Name: LYOTH LOADING STATION/CHEVRON <br /> Location: 26501 S BANTA RD <br /> TRACY 95376 <br /> Phone: <br /> Mailing Address: 4233 W SIERRA MADRE ST 209 <br /> care of: STEVE STRAIT <br /> FRESNO, CA 93722 <br /> Location Code: 99 APN: fnJt 17 1 <br /> BOS District: 005 SIC Code: A19 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION ` D® Fa(CCu#i✓2 Pa klJcul <br /> (5�D)64,A- 8Ss Sax n GA- 94593 00 <br /> ACCOUNT ID: 0008703 New Account ID: 000 <br /> Mail Invoices to: Account Mail Invoices to: Owner / Facility / Account <br /> Account Name: EMCON (Circle one) <br /> Account Balance as of 04/10/97: $0 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> 2960 RWOCB CLEAN UP SITE PR505092 0942 LAGORIO ACTIVE Y N A I D <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be biLLed to the party identified as the <br /> BILLING PARTY on this form. I also certify that aLL operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. - -- -- <br /> APPLICANT'S SIGNATURE: Date <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - <br /> PR Records to be TRANSFERED: x $20.00 = Amount,Paid Date_/ / <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid Date_/ / <br /> Payment Type Check # _. Recvd by <br /> REHS or COUNTER SUPV: Date_/_/_ ACCT out: Date/d0-/ / /7 UNIT/File:_/_/_ <br />