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Date run 10/12/2020 4:28:21P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/12/2020 <br /> Record Selection Criteria: Facility ID FA0023563 <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: 1 SSN/Fed Tax ID <br /> Owner ID OW0021854 New Owner ID <br /> Owner Name CHEVRON ENVIRONMENTAL MANAGEMEN <br /> Owner DBA <br /> OwnerAddress 6101 BOLLINGER CANYON RD <br /> SAN RAMON, CA 94583 <br /> Work/Business Phone Not Specified <br /> Alternative Phone 925-790-6272 <br /> Mailing Address 6101 BOLLINGER CANYON RD <br /> SAN RAMON, CA 94583 <br /> Care of <br /> FACILITY FILE INFORMATION APN 13526016 <br /> Facility ID/CERS ID FA0023563 <br /> Facility Name DELTA MARINE SALES AND SERVICES <br /> Location 401 N SAN JOSE ST <br /> STOCKTON, CA 95203 <br /> Phone <br /> Mailing Address 6101 BOLLINGER CANYON RD <br /> SAN RAMON, CA 94583 <br /> Care of <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0043477 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ARCADIS US INC (Circle One) <br /> Email invoice to(up to 2 emails) <br /> Email permit to(up to 2 emails) <br /> Account Balance as of 10/12/2020: $0.00 In`l `�a-{� (Circle One) <br /> ` Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2960-RWQCB LEAD AGENCY CLEAN UP SITE PR0541148 EE0001453-NUEL HENDERSON Active Y N A 0 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 als nify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. (n , <br /> V <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSF ED: *$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received <br /> EHD Staff: Date / / Account out: Date_ZQ <br /> COMMENTS: <br /> Invoice#: <br />