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H a <br /> Run by DIANE SAN JOAQUTA"LO(1NTY PUBLIC HEALTH SERVICES 0 <br /> Report #5021 FACILITY INFORMATION as of 08/02/94 <br /> -------------------------------------------------------------- <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION Date of INFORMATION CHANGE: <br /> Date of OWNERSHIP CHANGE: <br /> OWNER ID: 003439 New Owner ID• 00 <br /> Owner Name: U S DEPT OF ENERGY <br /> Owner DBA: LLNL — SITE 3-- BLDG 877 (,,,(„_N L. a'£O 6LD&15 839 eF )9)'41 <br /> Owner Address: 1333 BROADWAY <br /> OAKLAND, CA 94612 <br /> Home Phone: <br /> Work/Business Phone: 510-273-4135 <br /> Mailing Address: 1333 BROADWAY <br /> Care of: U S DEPT OF ENERGY <br /> OAKLAND, CA 94612 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 004531 <br /> Facility Name: LLNL—SITE 300 BLDG 877 �.N� Slr� 3aa - ,�,S�P,34 t", <br /> Location: CORRAL HOLLOW RD <br /> TRACY 95376 <br /> Phone: 510-422-3430 Q <br /> Mailing Address: PO BOX 808 <br /> care of: LLNL/C SUSI JACKSON LLNL G��� ( CIC. lE f.1 R1 <br /> LIVERMORE, CA 94550 <br /> Location Code: 9 9 APN: <br /> BOS District: 99 SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0004272 New Account ID: 000 <br /> Mail Invoices to: Facility Mail Invoices to: Owner / Facility <br /> Account Name: LLNL—SITE 300 BLDG 877 <br /> Account Balance as of 08/02/94 . $ —140. 40 <br /> FILES LINKED: No WATER SYSTEM FILE linked <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> ------------------------------------------------------------------------------- <br /> 2951 UGT-CAP 019458 0963 HINSON ACTIVE Y N A I D <br /> -----------------------� �J (� GCS 5�,-�o <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 / 9 <br /> ------------------------------------------------------------------------------- <br /> Programs to be TRANSFERED: x $20.00 = Amount Paid Date <br /> Payment Type Check # Recvd by <br /> ------ ------ <br /> ------------------------------------------------------------ <br /> ---------- — ---------------------------------------------- <br /> REHS or COUNTER SUPV: --- Date g / Z ICA— ACCT out:— Date—/_/9_ UNIT/File• / /9 <br />