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Date <br /> Run b n 5/13/2008 10:42:53AI SAN JCWIN COUNTY EN ONMENTAL HEA DEPARTMENT Report#5021 <br /> y Pagel <br /> Facility Information as of 5/13/20 <br /> Recerd Selection Catena: Facility ID FA 0005437 <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 OW0004278 New Owner ID <br /> Owner Name TOSCO DISTRIBUTING CO <br /> Owner DBA UNOCAL BULK PLANT#0788 <br /> Owner Address 9645 SANTA FE SPRINGS RD <br /> SANTA FE SPRINGS, CA 90670 <br /> Home Phone 562-906-7563 <br /> Work/Business Phone Not Specified <br /> Mailing Address 9645 SANTA FE SPRINGS RD <br /> SANTA FE SPRINGS, CA 90670 <br /> Care of TOSCO DISTRIBUITNG CO <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0005437 <br /> Facility Name UNOCAL BULK PLANT#0788 <br /> Location 8203 W 11TH ST <br /> TRACY, CA 95376 <br /> Phone <br /> Mailing Address 9645 SANTA FE SPRINGS RD <br /> SANTA FE SPRINGS, CA 90670 <br /> Care of TOSCO DISTRIBUTING CO <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOIS District 005-ORNELLAS, LEROY Fax <br /> APN 25014003 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name PENNY <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION v� c '�j� <br /> Account ID AR0005905 <br /> Mail Invoices to Facility C` \40 ew Account ID: <br /> ," >� Mail Invoices to: Owner / Facility / Account <br /> Account Name (1 'o\ (circa One) <br /> Account Balance as of 5/13/2008: $0.00 �(\ <br /> (Circle One) <br /> Program/Element and DescriptionTransferlo Active/Inaolve <br /> Record ID Employee ID and Name Status New Owner? Delete <br /> 2953-LCL HW CLEANUP SITE PR0502410 EE0006219-LORI DUNCAN Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned awner,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 term. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> Slate and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> (, ! / <br /> Program Records to be TRANSFERED: •$20.00= Amount Paid 5ozef Date 5 /12 / <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date / / <br /> Payment Type iz/.�L_Check Number Received by�-6r-I L4 q <br /> Lrl <br /> RENS: Date / / Account out: Date �Z/ / 0 O <br /> COMMENTS: N/t��/ ,(1 <br /> [� <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />