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Run by : LAURIEB 50.tonoo' Joaquin County PHS/EHD ~ Report #5021 <br /> FACILITY INFORMATION as of 05/30/96 <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date): <br /> OWNERSHIP CHANGE (date): <br /> OWNER ID: 005242 New Owner ID: 00 <br /> owner Name: CARDOZA PROPERTIES INC <br /> Owner DBA: <br /> Owner Address: 1630 CONTRA COSTA BLV STE 212 <br /> PLEASANT HILL, CA 94523 <br /> Home Phone: 510-676-6677 <br /> Work/Business Phone: 510-676-6677 <br /> Mailing Address: 1630 CONTRA COSTA BLV STE 212 <br /> care of: CARDOZA PROPERTIES INC <br /> PLEASANT HILL, CA 94523 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 006510 <br /> Facility Name: CHEVRON PIPELINE <br /> Location: GRANT LINE & CORRAL HOLL <br /> TRACY 95376 <br /> Phone: 510-676-6677 <br /> Mailing Address: PO BOX 5059 <br /> Care of: DON CULBERTSON KAk` <br /> SAN RAMON, CA 94583-0959 <br /> Location Code: APN: 214-020-10 r� <br /> BOS District: SIC Code: r J <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0008649 New Account ID: 000 <br /> Mail Invoices to: Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name: CHEVRON PIPELINE (Circle one) <br /> Account Balance as of 05/30/96 : $156.00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> r� - - - - - - - - - - --- --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> 2960 RWQCB CLEAN UP SITE PR5050701 0684 INFURNA ) ACTIVE Y N A I D <br /> - -- - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <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 <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid Date <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid Date—/—/ <br /> Payment Type Check # Recvd by <br /> REHS or COUNTER SUPV Date / / ACCT out Date L)7/ `74 /th h UNIT/File: <br /> "" f <br />