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Date run 8/20/2008 3:49:57PN SAN JWUIN COUNTY ENVIRONMENTAL HEH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/20/208 <br /> Record Selection Criteria: Facility ID FA0004011 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002758 New Owner ID <br /> Owner Name PORT OF STOCKTON <br /> Owner DBA PORT OF STOCKTON <br /> Owner Address 2201 W WASHINGTON ST <br /> STOCKTON, CA 95203 <br /> Home Phone 209-946-0246 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 2089 <br /> STOCKTON, CA 952012089 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0004011 <br /> Facility Name PORT OF STOCKTON-FUEL TERMINAL <br /> Location NAVYIWASHINGTON DR <br /> STOCKTON, CA 95203 <br /> Phone 213-486-1293 <br /> Mailing Address 999 THIRD AVE, STE 4000 <br /> SEATTLE, WA 98104 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -GUTIERREZ, STEVE Fax <br /> APN EMail: <br /> EMERGEDICY NOTIFICATION CONTACT INFORMATION <br /> Contact Name E )CON ASSOC/S LOFHOLM <br /> Title <br /> Day Phone 213-486-1293 <br /> Night Phone 213-486-1293 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003641 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SECOR INTERNATIONAL INC (Circle One) <br /> Account Balance as of 8/20/2008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Omen Delete <br /> 2960-RWOCB SITE PR0009171 EE0000997-HARLIN KNOLL Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andtor project specific,PHS/EHD houry charges associated witli this <br /> facility or activity will be billed to the party identified as the OWNER on this forth. 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. Q <br /> APPLICANTS SIGNATURE: •� Date V / Lam' / <br /> mOg <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid� Date <br /> Water System to be TRANS RED: '$372.00=—�--�—� Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / /_ Account out: Date <br /> COMMENTS: <br /> \\phs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />