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Run by : LAURIEB SafoJoaquin County PHS/EHD 0 Report #5021 <br /> FACILITY INFORMATION as of 05/28/96 <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 /> Work/Business Phone: <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 \Q �Q { <br /> }�C \ 1 0 <br /> //--� <br /> Location Code: 99 APN: �rx.0C�D 6�(JI�G(,Qj An <br /> BOS District: 005 SIC Code: (J <br /> �3oq <br /> ACCOUNTS RECEIVABLE FILE INFORMATION 2S2D 937A,-- <br /> ACCOUNT ID: 0008703 ?rQVIOUS bi l kii- 6004-ees& New Account ID: 000 <br /> Mail Invoices to: Account ?D. &Y- 3`� ol`ll' Mail Invoices to: Owner / Facility / Account <br /> Account Name: EMCON SaCY0.rvl&Uj), CA 958"3`x- -CIo `�'• (Circle one) <br /> Account Balance as of 05/28/96 : $429 . 00 l (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: 1, 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. 1 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 /> / <br /> Payment Type Check # Recvd by <br /> REHS or COUNTER SUPV Date_/_/_ ACCT out: Date/ 0-6 / UNIT/File:_/ / <br />