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OF <br /> ( � <br /> Run by : STAFF SG 'i Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 01/04/96 <br /> ------------------------------------------------------------------------------- <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: 002758 New Owner ID: 0 0 <br /> Owner Name: PORT OF STOCKTON <br /> Owner DBA: <br /> Owner Address: 2526 W WASHINGTON <br /> STOCKTON, CA 95203 <br /> Home Phone: <br /> Work/Business Phone: 209-467-3838 <br /> Mailing Address: 2526 W WASHINGTON <br /> care of: PORT OF STOCKTON <br /> STOCKTON, CA 95203 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 004519 <br /> Facility Name: PM--AS--PROD (UNOCAL) &xxzaAz <br /> Location: 2130 W WASHINGTON <br /> STOCKTON 95203 <br /> Phone: 209-467-3838 <br /> Mailing Address: 2000 CROW CANYON PL STE 400 <br /> Care of: UNOCAL (CERT) W T NI CKERSON <br /> SAN RAMON, CA 94583 <br /> Location Code: 01 APN: 145 030 0 9 <br /> BOS District: 001 SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0004203 New Account ID: 000 <br /> Mail Invoices to: Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name: PM AG PROD (UNOCAL) (Circle one) <br /> Account Balance as of 01/04/96 : $0 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> ------------------------------------------------------------------------------- <br /> 2960 RWQCB CLEAN UP SITE PR008999 0684 INFURNA ACTIVE Y N A I D <br /> ------------------------------------------------ - ------------------------------ <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> ------------------------------------------ ----------------------------------- <br /> PR Records to be TRANSFERED: x $20.00Amouht Paid Date <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid Date <br /> Payment Type Check # //Recvd by <br /> REHS or COUNTER SUPV Date/ /7 ACCT out:. Date/ �j UNIT/File: <br /> __ ___ ______________________________________________ <br />