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Date run 812400 12:08:26PM SANf6QUIN COUNTY PUBLIC HEALTH SE ES ♦ Report #: 0002 <br /> Run bye VDAVIS Facility Information as of 8/24/00 Page #: 1 <br /> Record Selection Criteria: Facility ID FA0006988 <br /> Record ID <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNERSHIP CHANGE (date) <br /> OWNER FILE INFORMATION <br /> Owner ID: OW0004745 New Owner ID <br /> Owner Name: TRACY, CITY OF <br /> Owner DBA <br /> Owner Address: 520 TRACY BLVD <br /> TRACY, CA 95376- <br /> Home Phone: 209-836-4420 <br /> Work/Bussness Phone: Not Specified <br /> Mailing Address: 520 TRACY BLVD <br /> TRACY, CA 95376- <br /> care of: TRACY, CITY OF <br /> FACILITY FILE INFORMATION <br /> Facility ID: 988 / ?A/r� �✓ i iC o/ <br /> Facility NameeALDEN: ALDEN PARK CHEVRON / �1 <br /> Location: 500 N SEQUOIA AVE <br /> TRACY, CA 95376 &,V, FO/� <br /> Phone: 953-76 941.593 <br /> Mailing Address: 520 TRACY BLVD <br /> TRACY, CA 95376- <br /> care of: TRACY, CITY OF <br /> Location Code: 03 -TRACY APN; <br /> BOS District 005-CABRAL, ROBERT sic code; <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID; AR0009998 New Account ID:: <br /> Mail Invoices to: AQe0b tt Mail Invoices to: OWne / Fa /Account <br /> Account Name: CHEVRON PIPELINE CO ) <br /> Account Balance as of 8/24/00: $446.16 <br /> (Circle One) <br /> UST(s) Transfer to Active/Inacty <br /> Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br /> 2960-RWQCB CLEAN UP SITE PRO505768 EE0000684-INFURNA Active Y N I <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that a//site,andlorproject <br /> specific,PHSIEHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on thisform I <br /> also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and Slate and/or Federal Laws <br /> APPLICANTS SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: '$150.00= Amount Paid Date <br /> Payment Type Check Number Receipt Number � /,� Received by <br /> REHS: Date / / Account out: �� Date <br /> 1.0.0.89.00 <br />