Laserfiche WebLink
Date run : 10/4/00 8:04:02AM SANAQUIN COUNTY PUBLIC HEALTH SEES Report #: 0002 <br /> Run by MINFURNA Facility Information as of 10/4/00 Page #: 1 <br /> Record Selection Criteria: FacilityID FA0006988 <br /> Record lD <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE (date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE (date) <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: FA0006988 <br /> Facility Name: ALDEN PARK CHEVRON <br /> Location; 500 N SEQUOIA AVE <br /> TRACY, CA 95376 <br /> Phone; 953-76 <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 to: AR00 9998 New Account ID:: <br /> Mail InvoicesCIZ CCOUnt Mail Invoices to: Owner/ Facili�AccountAccount Name; CHE PIPE LINE CO (Circle <br /> Account Balance as of 10/4/00:14Z750 4.44. t �/r_ <br /> (Circle One) <br /> UST(s) Transfer to Active/Inactve <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 A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,and/or <br /> project specific,PEIS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this <br /> form. I also certify that all operations will be performed in accordance with all applicable Ordinsce Codes and/or Standards and State and/or Federal <br /> Laws. <br /> APPLICANTS SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: '$0.00= Amount Paid Date <br /> Water System to be TRANSFERED: `$150.00= Amount Paid Date <br /> Payment Tye Check Number Receipt Number y-�--Received by <br /> REHS: Date / / /0(0 AccountoutDate <br /> GUMML <br /> 1.0.0.89.00 <br />