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SITE INFORMATION AND CORRESPONDENCE
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2900 - Site Mitigation Program
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PR0009275
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
1/7/2020 2:58:37 PM
Creation date
1/7/2020 2:10:04 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0009275
PE
2960
FACILITY_ID
FA0004014
FACILITY_NAME
VALERO ENEREGY CORP/NUSTAR ENERGY
STREET_NUMBER
3505
STREET_NAME
NAVY
STREET_TYPE
DR
City
STOCKTON
Zip
95203
APN
16203003
CURRENT_STATUS
01
SITE_LOCATION
3505 NAVY DR
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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Date run 9/10/2013 12:57:50PI SAN JOIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/10/2013 <br /> Record Selection Criteria: Facility ID FA0004014 <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 OW0002953 New Owner ID <br /> Owner Name NUSTAR ENERGY LP <br /> Owner DBA NUSTAR LP <br /> Owner Address PO BOX 781609 <br /> SAN ANTONIO, TX 78278 <br /> Home Phone 916-558-7609 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 781609 <br /> SAN ANTONIO, TX 78278 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0004014 <br /> Facility Name CONOCO PHILLIPS <br /> Location 3505 NAVY DR <br /> STOCKTON, CA 95203 <br /> Phone 916-558-7609 <br /> Mailing Address 3505 NAVY DR <br /> STOCKTON, Cl, 95203 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16203003 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name SHELBY LATHROP <br /> Title <br /> Day Phone 916-558-7609 <br /> Night Phone 209-464-8772 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003644 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ATC ASSOC, INC (Circle One) <br /> Account Balance as of 9/10/2013: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB SITE PR0009275 EE0000997-HARLIN KNOLL 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 facility <br /> 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 Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br />
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