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Date run 8/26/2003 1:42:57PN SAN JJJJJJJ,W4 UIN COUNTY ENVIRONMENTAL HE H DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/26/2003 <br /> Record Selection Criteria: Facility ID FA0013750 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0010851 New Owner ID <br /> Owner Name CHEVRON TEXACO CO <br /> Owner DBA <br /> Owner Address PO BOX 61�-zSr /L <br /> SAN RAMON, CA 945830725 — 0712— <br /> Home <br /> 71ZHome Phone 925-842-1341" <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 6025 <br /> SAN RAMON, CA 945830725 <br /> Care of DENNIS TRIPLITT <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013750 <br /> Facility Name CHEVRON TEXACO COQ€-IRL*-fXA <br /> Location 800 W BEECHNUT <br /> TRACY, CA 95376 <br /> Phone 925-842-1341 <br /> Mailing Address PO BOX 60g 1 a1 It :2, <br /> SAN RAMON, CA 945830725 --O?/2- <br /> Care of DENNIS TRIPLtfifi i ✓7 t oc.w-� <br /> Location Code 03 -TRACY APN: <br /> BOS District SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0023053 New Account ID: <br /> Mail Invoices tont Mail Invoices to: Owner / Facility / Account <br /> Account Name CHEVRON ENVIRONMENTAL MGMT CO (Circle One) <br /> Account Balance as of 8/26/2003: $-178.00 <br /> (Circle One) <br /> Transfer to Active/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0518187 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 site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. 1 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 Numberce' a by <br /> REHS: Date / / Account out: Date_P /02L <br /> COMMENTS: Yf T <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />