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Date run 9/19/2013 9:08:55AK SAN JO/ IN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Runty Pagel <br /> Facility Information as of 9/19/2013 <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 u <br /> Location 3505 NAVY DR <br /> STOCKTON, CA 95203 <br /> Phone _SID -'-TU I1-)7 6 Ek7 /I O <br /> Mailing Address 3 � <br /> 3 O SA-„) <br /> Care of CP-0 CKET7 <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16203003 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION n t� <br /> Contact Name 61 IE BY t Ar�_� K'C44-g D K�jotlles <br /> Title 'L-.g-C,1 J''A'L SL /4&)Q— <br /> Day <br /> Day Phone Q46.558-74&Q$ 510 -''7s!7-I 0-7 1, bv7. /I f7 <br /> Night Phone 209-464_87-7Y2, <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 9/19/2013: $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 E€8 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknow edge that all sit`e1and/r 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: o'�� f'� �C � 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 Receivedy <br /> REHS: Date / / Account out: i� Date / 1-7 <br /> COMMENTS: <br />