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Daterun 9/5/2003 12:29:41 PM SAN JO COUNTY ENVIRONMENTAL HEAADEPARTMENT Report#5021 <br /> Run by Pagel <br /> r Facility Information as of 9/5/20 <br /> Record Selection Criteria: FacilityID FA0004015 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002954 New Owner ID <br /> Owner Name SHELL OIL <br /> Owner DBA SHELL OIL CO(STOCKTON PLANT) <br /> Owner Address 15TH S RIVER DR <br /> WEST SACRAMENTO, CA 95691 <br /> Home Phone 916-372-3116 <br /> Work/Business Phone 916-372-3116 <br /> Mailing Address 15TH S RIVER DR <br /> WEST SACRAMENTO, CA 95691 <br /> Care of JOHN WALKER <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0004015 <br /> Facility Name SHELL OIL (STOCKTON PLANT) <br /> Location 3515 NAVY DR <br /> STOCKTON, CA 95206 <br /> Phone 209-466-6941 �� AA <br /> Mailing Address PO BOX 6249 <br /> CARSON, CA 90749 p <br /> Care of CHRIS DAVIES-ENV ENGINEER <br /> Location Code 01 -STOCKTON APN: <br /> BOB District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003645Q� 4� New Account ID: <br /> Mail Invoices to Account UU Mail Invoices to: Owner / Facility / Account <br /> L „tib`. moo,.,. 'J. E'L L D I S <br /> Account Name �yR— � roR „« (Circle one) <br /> Account Balance as of 9/5/2003: $178.00 v j NG#-.39,900 <br /> Transfer to (Cirole One) <br /> Active/Inattwe <br /> Program/Element and Description Record ID Employee 10 and Name Status New Owner! Delete <br /> 2960-RWOCB CLEAN UP SITE(SLIC) PR0009241 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,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 amordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: '$155.00= Amount Paid a / / <br /> Payment Type Check Number <br /> REHS: Date / / Account out: ate / / 35 <br /> COMMENTS: <br /> \\Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />