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Date run 3/8/2006 2:06:11PM SAN JO*VIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run by 4006 0 Pagel <br /> Facility Information as of 3/8/2006 <br /> Record Selection Criteria: Facility ID 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 <br /> Mailing Address PO BOX 4912 <br /> HOUSTON, TX 772104702 <br /> �. Care of WHITWORTH, JEFF --_ <br /> Location Code 01 -STOCKTON APN:16203002 <br /> BOIS District 003 -MOW, VICTOR SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID A 45 New Account ID: <br /> Mail Invoices ACCOun Mail Invoices to: Owner / Facility ! Account <br /> Account Name SHELL OIL ( PA"'-ers (,k-s (Circle One) <br /> Account Balance as of 3/8/2006: $46.50 pE)a 0A 440 O +� <br /> ,/ r -7a o— Transfer to (Circle One) <br /> las-r0�! /)( I T�tAciive/InacNe <br /> Program/Element and Description Record In Employee ID and Name Status New Owner, <br /> Delete <br /> 2960-RWQCB SITE 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 spec,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the parry 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. //��� // I y/��7� , -7 p' <br /> APPLICANT'S SIGNATURE: / CM'v-rl.d"L 6 r'VY( L Date 7 / 0 10 (— <br /> Program <br /> bLProgram 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 I Account out: Zig Date <br /> COMMENTS: <br /> \\p hs-ehsql-nt\apps\envis ions\reports\5021.rpt <br />