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x, <br /> Run h : STAFF S(*r Joa 'uin County PHS/EHD Report #5021 <br /> Ru y q <br /> FACILITY INFORMATION as of 07/25/96 <br /> -------------------------------------------------------------------------------- <br /> Make changes/corrections in RED pen or pencil: I <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: 005690 New Owner ID: 00 <br /> Owner Name: ARCO <br /> Owner DSA: <br /> owner Address: 4 CENTERPOINTE DR STE 300 <br /> c LA PALMA, CA 90623 <br /> Home Phone: 408-259-4613 <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: 2155 S BASCOM AVE STE 202 <br /> Care of= KYLE E <br /> CAMPBELL, CA95008 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 006929 <br /> Facility Name: ARCO PRODUCTS CO #5569 r <br /> Location: 3 518 E HAMMER LN <br /> STOCKTON 95212 <br /> Phone: 408-378-8696 <br /> Mailing Address: 2155 S BASCOM AVE STE 202 <br /> care of: KYLE CHRISTIE <br /> CAMPBELL, CA 95008 <br /> Location Code: 01 APN: <br /> Bos District: 002 SIC Code: 2.950 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0009810 New Account ID: 000 <br /> Mail Invoices to: Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name: ARCO (Circle one) <br /> Account Balance as of 07/25/96 : $0 . 00 (Circle on <br /> Record UST(s) Transfer to Activate Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delet <br /> -------^-------- ----------- ---------------------------------------D------- <br /> / / <br /> 2 0 ENVIjRq-�� ASSESS �J'--��---PR505662 - 0684 INFURNA✓ -_^ ACTIVE- Y--N------A ! I ) --------..... <br /> ----!---------------------- <br /> BILLING <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 $150.60 ,= Amount Paid Date <br /> Payment Type1/7� . Check # Recvd by <br /> REAS or COUNTER SUPV: v� Date <br /> -7 ACCT ACCT out Date/ /� UNIT/Pile: / ^/ <br />