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Runby : STAFF San Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 09/23/98 <br /> ------------------- -----------=------------ ------------------------- ---=------ <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) ; <br /> OWNERSHIP CHANGE (date) : <br /> ) <br /> OWNER ID: 006569 New Owner ID: 0 0 <br /> Owner Name: DOBLER, LOUIE - <br /> Owner DBA: <br /> Owner Address: 276 W 20TH ST <br /> T C CA 95376 <br /> Home Phone: 2 0-9 3-6-3316 <br /> - <br /> Scc Sects / Tax ID#: S #5 9-44-8690 <br /> ownership Type: 01 CORPORATION <br /> Mailing Address: 276 W 20TH ST <br /> Care of: <br /> TRACY, CA 95376 j <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007948 . <br /> Facility Name: DOBLER, LOUIE <br /> Location: 276 W 20TH ST <br /> TRACY 95376 <br /> Phone: <br /> Mailing Address: 276 W 20TH ST <br /> Care of: LOUIE DOBLER <br /> TRACY, CA 95376 <br /> Location Code: APN: I <br /> BOS District: SIC Code: <br /> i <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0014708 New Account ID: 000 <br /> Mail Invoices to: Account e Mail Invoices to: Owner / Facility / Account <br /> Account Name: CHEVRON PIPE E C (circle one) <br /> Account Balance as of 0 9/2 3/9 8 : $-15 6 . 0 0 (Circle one) <br /> Reco UST(s) Transfer to Activate / Inactivate <br /> i <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> ---------------- ----- --------------- ------------------------ ---- ------ - ------ 1 <br /> 2950 ENVIRON ASSESS PR506113 0684 INFURNA ACTIVE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 2 the undersigned owner, operator or agent of same, acknowledge that all site and/or I <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the t <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 /> ----------------- ---- ---------------------------------------------------_------- J <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid Date - <br /> Wat_er.Svstem to be TRANSFERED: x $150.00 = - Amount Paid Pate / / '- <br /> Payment Type Check # Recvd by <br /> ----------------------------------------------------------------------- -___---- <br /> REHS or COUN'T'ER SUPV; - Date-/-/ ACCT out: Date / / UNIT/File: / / <br />