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r <br /> Date run 7/8/2014 8:31:22AM SAN JOA N COUNTY ENVIRONMENTAL HEAL' )EPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/8/2014 <br /> Record Selection Criteria: Facility ID FA0019174 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 SSN/Fed Tax ID <br /> Owner ID OW0011397 New Owner ID <br /> Owner Name LINCOLN PROPERTIES LTD <br /> Owner DBA LINCOLN PROPERTIES LTD <br /> Owner Address 374 LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Home Phone 209-478-9200 <br /> Work/Business Phone Not Specified <br /> Mailing Address 374 LINCOLN CENTER <br /> STOCKTON, CA 95207 <br /> Care of BILL JOHNSON <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0019174 <br /> Facility Name CHEVRON SERVICE STATION 9-6171 <br /> Location 6633 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone <br /> Mailing Address PO BOX 7611 <br /> SAN FRANCISCO, CA 94120 <br /> Care of LINCOLN PROPERTIES LTD <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 09741048 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION Nrl5gf <br /> ContactName JOHNSON, PHIL — v , <br /> Title <br /> Day Phone 209-478-9200 (7 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034126 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CHEVRON ENVIRONMENTAL MGMNT CO (Circle One) <br /> Account Balance as of 7/8/2014: $0.00 �G�j� <br /> (Circle One) <br /> y 5 311 Transfer to Active/Inactve <br /> PrograMEI�Descri�(,ptiou d n Record ID Employee ID and Name Status New Owner7 Delete <br /> 2957-UST FILE-RWQCB PRO528433 EE0000684-MICHAEL INFURNA Inactive 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 facility <br /> 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 Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Receive by <br /> REHS: Date / / Account out: Received <br /> / /� <br /> COMMENTS: <br />