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Date rulT 12/2/2009 1:04:20PR SAN JOA(V COUNTY ENVIRONMENTAL HEALT&EPARTMENT Report#5021 <br /> Run by 4006 Pagel <br /> Facility Information as of 12/2/2009 <br /> Record Selection Criteria: Facility ID FA0003965 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OXFCISCO, <br /> New Owner ID : W U U C 7.95-7 <br /> Owner Name PAELECTRIC COMPANY <br /> Owner DBA <br /> Owner Address 77 <br /> SAO, CA 94106 <br /> Home Phone 20Work/Business Phone 92Mailing Address 37N SUITE 200 <br /> WA , CA 94598 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003965 <br /> Facility Name P G & E <br /> Location 4040 WEST LN <br /> STOCKTON, CA 95204 <br /> Phone 200-466-6W <br /> Mailing Address f43-gg)(4,430 <br /> STOCKTON. CA Q59013 O J,7 <br /> Care of Sfrl� hie 42T 4 X583 <br /> Location Code 01 -STOCKTON -S u <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 11702001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION n <br /> Contact Name per- S7h7t -rc-e-. 0'b AD Su L, <br /> Title 121 �,�� <br /> � <br /> Day Phone .29 _ s-� F T <br /> Night Phone Q TfF r�T(E <br /> ACCOUNTS RECEIVABLE FILE INFORMATION qZ$ -2 Q9 —`{3 D O DC Z3 7 <br /> Account ID AR0003581 NewAccount ID: <br /> Mail Invoices to Fagrmlq A-L'G-'r, Mail Invoices to: Owner / Facility Account <br /> Account Name P G & E STOCKTON SERVICE CENTE (cine one> <br /> 2ement <br /> alance as of 12/2/2009: $0.00 <br /> qj (Circle One) <br /> and Description Record ID Employee ID and Name Status Transfer to Active/mactve <br /> New Owner? Delete <br /> 2 -UGT-CAP PR0001963 EE0000997-HARLIN KNOLL Ina iv 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: /"ti-7T/�-C�-� / Y v.�j�, Date <br /> Program Records to be TRANSFERED: •$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: •$372.00= Amount Paid .' -Date (•?1 7—/< <br /> Payment Type Check Number 22SD3 Z Received by <br /> REHS: Date / / Account out: Date L Z-/ 2— <br /> COMMENTS:COMMENTS: <br /> \\ehenv\envision\reports\5021.rpt <br />