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Date•un 9/6/2002 10:51:37AM SAN J UIN COUNTY ENVIRONMENTAL HE20 DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Record Selection criteria Facility ID FA0004011 Facility Information as of 9/6/ <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner lD OW0002758 New Owner ID <br /> Owner Name PORT OF STOCKTON <br /> Owner DBA PORT OF STOCKTON <br /> Owner Address 2526 W WASHINGTON ST <br /> STOCKTON, CA 95203 <br /> Home Phone Not Specified <br /> Work/BusinessPhone 209-467-3838 <br /> Mailing Address 2526 W WASHINGTON ST <br /> STOCKTON, CA 95203 <br /> Care of PORT OF STOCKTON <br /> FACILITY FILE INFORMATION <br /> FacilityID FA0004011 <br /> Facility Name PORT OF STOCKTON-FUEL TERMINAL <br /> Location <br /> STOCKTON, <br /> Al" <br /> STOCKTON, CA 95203 <br /> Phone 213-486-1293 1 <br /> Mailing Address 3 q y' >r r,.p(,t�q ) 0 0 <br /> SEATTLE, W 96104 p O V <br /> Care of <br /> Location Code 01 -STOCKTON P <br /> PV <br /> BOS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003641 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name PORT OF STOCKTON (Circle One) <br /> Account Balance as of 9/6/2002: $178.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> New Owner? Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 2960-RWQCB CLEAN UP SITE PR0009171 ^r^n+be- '-' 1 e 1�r Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent o same,ack owletlge that a If she,Id/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 Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: "$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: `�Ln- �t�e Date Accountout: _JA Date <br /> COMMENTS: <br /> kv'e' <br /> \\Phs-ehsq I-nt\apps\Envisions\Reports\5021.rpt <br />