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Date mn 9/10/2013 2:00:34Ph SAN JOOIN COUNTY ENVIRONMENTAL HEAI*DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9110/2013 <br /> Record Selection Criteria: Facility 10 FA0019146 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0015748 New Owner ID <br /> Owner Name SHELL OIL PRODUCTS US <br /> Owner DBA <br /> Owner Address 20945 S WILMINGTON AVE <br /> CARSON, CA 90810 <br /> Home Phone 916-853-8927 <br /> Work/Business Phone Not Specified <br /> Mailing Address 20945 S WILMINGTON AVE <br /> CARSON, CA 90810 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility lD/CERS ID FA0019146 <br /> Facility Name SHELL OIL PRODUCTS US <br /> Location 3725 N TRACY BLVD <br /> TRACY, CA 95304 <br /> Phone 916-853-8927 <br /> Mailing Address 20945 S WILMINGTON AVE �� 2i� AGI G/ <br /> CARSON, CA 90810 <br /> Care of <br /> Location Code 03-TRACY Alt Phone <br /> BOB District 005- ELLIOTT, BOB Fax <br /> APN 21217030 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034092 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SHELL OIL PRODUCTS US (Circle One) <br /> Account Balance as of 9/10/2013: $-105.00 <br /> (Circle One) <br /> Transfer to ActiveJlnaclve <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner? <br /> 2950-ENVIRON ASSESS PRO628359 EE0000997-HARLIN KNOLL Active Y N <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. 1,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHS15HD hourly charges associated wi f 'ty <br /> or activity will be billed to the party identifed as the OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and Sta a a,dor <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 Received by l <br /> REHS: Date / / Account out �— Date 1111 /3 <br /> COMMENTS: <br />