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Date run 10/17/01 8:26:56AM SAN4#AQUIN COUNTY PUBLIC HEALTH SE WES Report #: 5023 <br /> Run by Facility Information as of 10/17/01 Page #: 1 <br /> f <br /> Record Selection Criteria: Facility ID FA0006743 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0005511 New Owner ID <br /> Owner Name: SANTA FE PACIFIC PIPELINE PTRS <br /> Owner DBA: <br /> Owner Address: 888 S FIGUEROA ST <br /> LOS ANGELES, CA 90017 <br /> Home Phone: 213-486-7739 <br /> Work/Business Phone: Not Specified <br /> Mailing Address: 888 S FIGUEROA ST <br /> LOS ANGELES, CA 90017 <br /> Care of: SANTA FE PACIFIC PIPELINE PTRS <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0006743 <br /> Facility Name: HOLT LEAK SITE <br /> Location: COOK RD <br /> HOLT, CA 95234 <br /> Phone: <br /> Mailing Address: <br /> Care of: <br /> Location Code: 99 - UNINCORPORATED AREA APN: <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0009208 New Account ID: <br /> Mail Invoices to: Account Mail Invoices to: Owner/Facility/Account <br /> Account Name: CH2M HILL (Circle One) <br /> Account Balance as of 10/17/01: $-267.00 <br /> (Circle One) <br /> Transfer to Active/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PR0505378 EE0000756-CAROL OZ 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,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt <br />