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------------------------- 0 ------------------------ * ----------------------- OWNER FILE INFORMATION OWNER ID: 005829 Owner Name: PG&E Owner DBA: PG&E-MCDONALD ISL Owner Address: MCDONALD ISLAND HOLT, CA 95234 Home Phone: Soc Sec# / Tax ID#: Ownership Type: 01 CORPORATION Mailing Address: P O BOX 106 care of: PG&E—MCDONALD ISLAND HOLT, CA 95234 FACILITY FILE INFORMATION FACILITY ID: 007096 Facility Name: P G & E-MCDONALD ISL Location: MCDONALD ISLAND HOLT 95234 Phone: Mailing Address: P O BOX 106 care of: PG&E-MCDONALD ISLAND HOLT, CA 95234 Location Code: 9 9 APN: BOS District: SIC Code: Make changes/corrections in RED pen or pencil: INFORMATION CHANGE (date): OWNERSHIP CHANGE (date): New Owner ID: 0 0 ACCOUNTS RECEIVABLE FILE INFORMATION �~ 4) ACCOUNT ID: 0010263 New Account ID: 000 ` Mail Invoices to: Facility Mail Invoices to: Owner / Facility / Account Account Name: P G & E-MCDONA ISL (Circle one) Account Balance as of 10/21/96 : $0.00 (Circle one) Record UST(s) Transfer to Activate / Inactivate P/E Description ID Employee Status Linked new owner? Delete 2229 GEN 50<250 TONS PERMIT PR505942 0418 KITH ACTIVE Y N A I D '1214 ------------—.-------------------------------------------------------- - - - - - - 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 facility or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date ------------------------------------------------------------------------------- PR Records to be TRANSFERED: x $20.00 = Amount Paid Date —/—/ Water System to be TRANSFERED: x $150.00 = Amount Paid Date Payment Type Check # Recvd by ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- REHS or COUNTER SUPV:i�e Date 10 / Zt /(p ACCT out: Date / 3 / UNIT/File: Runby :DOUGW San Joaquin County PHS/EHD Report #5021 FACILITY INFORMATION as of 10/21/96 ------------------------------------------------------------------------------- Make changes/corrections in RED pen or pencil: OWNER FILE INFORMATION INFORMATION CHANGE (date) :