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Date run 5/28/2008 10:55:15AI SAN JIN COUNTY ENVIRONMENTAL HEADEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5,'28/200 <br /> Record Selection Criteria'Facillty ID FA0006743 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <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 Site Mitigation Facility <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 gg - UNINCORPORATED A Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name SANTA FE PACIFIC PIPELINE <br /> Title <br /> Day Phone 213-486-7739 <br /> Night Phone <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 CH2MHILL INC (Circle One) <br /> Account Balance as of 5/28/2008: $0.00 <br /> (Circle One) <br /> T'^r sfer to Active/Inactve <br /> Program/Element and Description <br /> Record ID Employee ID and Name Status New,s Delete <br /> 2960-RWQCB 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: *$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsq I-nt\apps\envisi ons\reports\5021.rpt <br />