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Joaquin Count PHS/EHD • Report #5021 <br /> Run by . STAFF <br /> Joaq Y <br /> FACILITY INFORMATION as of 02/25/98 <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: 006051 New Owner ID: 0 0 <br /> Owner Name: CHEVRON PIPE LINE CO <br /> Owner DBA: <br /> Owner Address: 4000 EXECUTIVE PARKWAY STE4 0 0 <br /> SAN RAMON, CA 94583 <br /> Home Phone: 510-842-6877 <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: 4000 EXECUTIVE PARKWAY STE4 0 0 <br /> care of: MS KAT I E HOWER <br /> SAN RAMON, CA 94583 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007342 <br /> Facility Name: CHEVRON PIPELINE CO PROPERTY <br /> Location: 990 BEECHNUT AVE <br /> TRACY 95376 <br /> Phone: <br /> Mailing Address: 4000 EXECUTIVE PARKWAY STE4 0 0 <br /> care of: MS KATIE HOWER <br /> SAN RAMON, CA 94583 <br /> Location Code: 0 3 APN: <br /> BOS District: 0 0 5 SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0010950 New Account ID: 000 <br /> Mail Invoices to: Owner Mail Invoices to: Owner / FaCility / Account <br /> Account Name: CHEVRON PIPE LINE CO (Circle one) <br /> Account Balance as of 02/25/98 : $0 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/ Description ID Employee Status Linked new owner? Delete <br /> -- ------------ - - -- - - --------------------- <br /> 20 ENVIRON ASSESS PR506314 0684 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 <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 /> Date <br /> APPLICANT'S SIGNATURE: <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid <br /> ------ ------------------------------------------------------------------------ <br /> Date / / <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid Date <br /> Payment Type Check # 7 Recvd by <br /> RENS or COUNTER SUPV Date / / ACCT out Date Z / /� UNIT/File: / / <br />