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Run by : STAFF —0, Joaquin County PHS/EHD 40 Report #5021 <br /> FACILITY INFORMATION as of 07/30/97 <br /> ------ - - - - - -- -- - -- ------ - ------------------------------------------ <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: 006051 New Owner ID: 00 <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 KATIE HOWER <br /> SAN RAMON, CA 94583 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007342 <br /> ` /? <br /> Facility Name: aw� <br /> / C•(J <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: 005 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 0 7/3 0/9 7 : $0 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> ------------------------------------------------------------------------------- <br /> 2950 ENVIRON ASSESS PR506314 0684 INFURNA ACTIVE Y N A I 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 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 /> c//►L/ Payment Type Check # Recvd by <br /> UNIT/File: <br /> RENS or COUNTER SUPVyJ/%� Vvy Date__ ACCT out: Date Op _/_/__--/___ <br />