Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
Date run ' 4/17/01 10:04:06AM SAN Jr WIN COUNTY PUBLIC HEALTH SERVI('-=S Report tt: 0002 <br /> Fun by IFacility Information as of 4/17/01 Paye q" 1 <br /> Record Selection Criteria: I +cility ID FA0000514 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0000425 New Owner ID <br /> Owner Name: EQUILLON ENTERPRISES LLC <br /> Owner DBA: SHELL <br /> Owner Address: PO BOX 8080 <br /> MARTINEZ, CA 94553- <br /> Home Phone: Not Specified <br /> Work/Bussness Phone: 510-293-9150 <br /> Mailing Address: PO BOX 8080 <br /> MARTINEZ, CA 94553- <br /> Care of: AURA MATTIS <br /> FACILITY FILE INFORMATION <br /> Facility ID: FA0000514 <br /> Facility Name: MANTECA SHELL" <br /> Location: 1071 N MAIN ST <br /> MANTECA, CA 95336 <br /> Phone: 209-823-5265 <br /> Mailing Address: 305 KANSAS WAY <br /> FREMONT, CA 94539-7768 <br /> care of: AURA MATTIS <br /> Location Code: 04 -MANTECA APN; <br /> Bos District: 003 - MOW,VICTOR SIC Code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID: AR0000513 New Account ID:: <br /> Mall Invoices to: Facility Mail Invoices to: Owner/Facility/Account <br /> Account Name: MANTECA SHELL' (Circle One) <br /> Account Balance as of 4/17/01: $0.00 <br /> (Circle One) <br /> UST(s) Transfer to Active/inactve <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO514326 EE0007289-YOUNGBLOOD Active Y N A I D <br /> 1615-RETAIL MKT<2000 SO FT(PREPKGD ONLY PRO162175 EE0002685-BOOTH Active Y N A I D <br /> 2361-NEW MULTI UST FACILITY PR0231431 EE0007289-YOUNGBLOOD Active 10 Y N A I D <br /> 2950-ENVIRON ASSESS PRO506313 EE0007479-ROWE Active Y N A (1) D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE F PR0507250 EE0007289-YOUNGBLOOD Active Y N A 1 D <br /> 2301 -UST STATE SURCHARGE PRO507792 EE0007289-YOUNGBLOOD Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0512724 EE0000000-SJC OES Active Y N A I D <br /> BILLING and COMPLIANCE,Af KNOWLEDGFMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific, <br /> PHS/EIID hourly charges associated with this facility or activity will he billed to the party identified as the BILLING PARTY on this forniL I also certify that all <br /> operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / ! <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$150.00=_ Amount Paid Date <br /> Payment Type Check Number Receipt Number Received by <br /> REHS: Date Lf /_L1_/--aL Account out: Date`Z/ �7 /01 <br /> 10.0.89.00 <br />