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Run by ; L'AUKIEB SaqlJoaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of, 04/18/97 <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 /> wee) On 1v53Z <br /> FACILITY ID: O03 L/�LQJ � <br /> FaciLity Name: UL HOFFMAN & SONS <br /> Location: 26501 S BANTA RD <br /> TRACY 95376 <br /> Phone: 209-836-0775 <br /> Mailing Address: PO BOX 7924 <br /> care of: CHEVRON CORP/JANE MACKENZIE <br /> SAN FRANCISCO, CA 94120 <br /> Location Code: 03 APN: <br /> BOS District: 005 SIC Code: SZ <br /> ACCOUNTS RECEIVABLE FILE INFORMATION 1 ^vivi, <br /> ACCOUNT ID: 0 612 J7tA&'L-1 New Account ID: 000 $,10.3 <br /> Mail Invoices to: acuity Mail Invoices to: Owner / Facility / Account <br /> Account Name: PAUL HOFFMAN & SONS (Circle one) <br /> Account Balance as of 04/18/97 : $39 . 00 (CircLe o <br /> Record UST(s) Transfer to Activate Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delet <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> 2960 RWQCB CLEAN UP SITE PR009163 0942 LAGORIO ACTIVE Y N A 0 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 wi LL 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 <br /> ate_/ /Payment Type Check # Recvd by <br /> RENS or COUNTER SUPV Date_/_/_ ACCT out: 116 Date/71 /47-7 UNIT/File: <br />