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Run by : SANDY On Joaquin County PHS/EHD 0 Report #5021 <br /> FACILITY INFORMATION as of 10/31/96 <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date): <br /> OWNERSHIP CHANGE (date): <br /> OWNER ID: 006051 New Owner ID: 00 <br /> owner Name: CHEVRON PIPE LINE CO <br /> Owner DBA: <br /> owner Address: 4000 EXECUTIVE PARKWAY STE400 <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 STE400 <br /> care of: MS KATIE HOWER �j�0'�G'-a••�G�� G� <br /> SAN RAMON, CA 94583 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007342 <br /> Facility Name: RENOWN PROPERTY <br /> Location: 990 BEECHNUT AVE <br /> TRACY 95376 <br /> Phone: <br /> Mailing Address: 4000 EXECUTIVE PARKWAY STE400 <br /> care of: MS KATIE HOWER <br /> SAN RAMON, CA 94583 <br /> Location Code: 0 3 APN: <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0010950 New Account ID: <br /> Mail Invoices to: acl It O Mail Invoices to: Owner Facility / Account <br /> Account Name: RENOWN PROPERTY rcle one) <br /> Account Balance as of 10/31/96 : $70 .20 (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 /> Payment Type Check # Recvd by <br /> REHS or COUNTER SUPV Date—/—/- ACCT out: Date/ / UNIT/File: <br /> YV i -lam <br /> wvmv�- f' U( &e, Rot <br /> 0 e ?7-e <br /> 5 r P °� <br />