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pate run , 8/2/2006 3:17:08PM SAN JOF "IN COUNTY ENVIRONMENTAL HEAL" DEPARTMENT Report#5021 <br /> Run by ' Pagel <br /> Facility Information as of 8/2/2001, <br /> Record Selection Criteria: FiW ID FA0017741 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0014568 New Owner ID <br /> Owner Name CATELLUS TRACY, LLC <br /> Owner DBA <br /> Owner Address 2377 CRENSHAW BLVD#251 <br /> TORRANCE, CA 90501 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 2377 CRENSHAW BLVD#251 <br /> TORRANCE, CA 90501 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0017741 <br /> Facility Name CATELLUS/CHEVRON PIPELINE ENV MGM- <br /> Location 14824 W GRANT LINE RD <br /> TRACY, CA 953047216 <br /> Phone <br /> Mailing Address o \t J <br /> , S 3 5 b <br /> TnO F\ Seauy%A <br /> Ca , gDayS - 459 <br /> Care of CATELLUS TRACY, LLC <br /> Location Code 99 - UNINCORPORATED AREA APN:20927005 <br /> BOS District 005 - ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0030953 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CATELLUS/CHEVRON PIPELINE ENV MGMT (CirdeOne) <br /> Account Balance as of 8/2/2006: $111.60 <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 PR0526219 EE0000684-MICHAEL INFURNA Active Y N A 1 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 <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: S¢ e- 0.'tk a Date Z /0L_ <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> RENS: Date / / Account out: Date / 2— <br /> COMMENTS: <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />