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Date run 4/23/01 9:14:33AM SPWAQUIN COUNTY PUBLIC HEALTH Sr9ICES Report #: 0002 <br /> Run by Facility Information as of 4/23/01 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0007342 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0006051 New Owner ID <br /> Owner Name: CHEVRON PIPE LINE CO <br /> Owner DBA: <br /> Owner Address: 6001 BOLLINGER CANYON RD <br /> SAN RAMON, CA 94583- <br /> Home Phone: 925-842-1341 <br /> Work/Bussness Phone: Not Specified <br /> Mailing Address: PO BOX 6012 <br /> SAN RAMON, CA 94583- <br /> Care of: ROBERT D MIHALOVICH <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0007342 <br /> Facility Name: CHEVRON PIPELINE/RENOWN PROPERT <br /> Location: 990 BEECHNUT AVE <br /> TRACY, CA 95376 <br /> Phone• <br /> Mailing Address: 6001 BOLLINGER CANYON RD RM #K2072 <br /> SAN RAMON, CA 94583- <br /> Care of: ROBERT D MIHALOVICH <br /> Location Code: 03 -TRACY APN; <br /> Bos District: 005 - BEDFORD, LYNN SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0010950 New Account ID:: <br /> Mail Invoices to: Account Mail Invoices to: Owner/Facility/Account <br /> Account Name: CHEVRON ENVIRONMENTAL MANAGEMENT CO (Circle One) <br /> Account Balance as of 4/23/01: $0.00 <br /> (Circle One) <br /> LIST(s) Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PRO506314 EE0000684-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, <br /> PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all <br /> operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: *$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Type Check Number Receipt Number Received by <br /> REHS: Date / / Account out: Date <br /> 1.0.0.89.00 • �. <br />