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Date run 4/6/2018 4:19:33PM <br />Run by <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Pagel <br />Facility Information as of 4/6/2018 <br />Record Selection Criteria: Facility ID <br />FA0009697 <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 : 28 SSN / Fed Tax ID <br />Owner ID <br />OW0002957 New Owner ID <br />Owner Name <br />Pacific Gas and Electric Company <br />Owner DBA <br />PG&E <br />OwnerAddress <br />3401 CROW CANYON RD 176C <br />SAN RAMON, CA 94583 <br />Home Phone <br />925-415-6381 <br />Work/Business Phone <br />415-973-7000 <br />Mailing Address <br />c/o Environmental Services, 3401 Crow Canyc <br />San Ramon, CA 94583 <br />Care of <br />c/o Environmental Services <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0009697 <br />Facility Name <br />PG&E VERNALIS DEHYDRATOR <br />Location <br />1688 E DURHAM FERRY RD <br />TRACY, CA 95304 <br />Phone <br />209-942-5020 <br />Mailing Address <br />375 N WIGET LN <br />WALNUT CREEK, CA 94598 <br />Care of <br />PACIFIC GAS & ELECTRIC CO <br />Location Code <br />Alt Phone <br />BOS District <br />005 - ELLIOTT, BOB Fax <br />APN <br />25523002 Entail: <br />EMERGENCY NOTIFICATION <br />CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID <br />AR0016697 New Account ID: <br />Mail Invoices to <br />Facility Mail Invoices to: Owner / Facility / Account <br />Account Name <br />PG&E VERNALIS DEHYDRATOR (Circle One) <br />Account Balance as of 4/6/2018: $0.00 <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br />I `?.)�1{3P6—HMBP-Remote Network Location PR0511985 EE0000009 - NICHOLAS LOEHRER Active Y N A I D <br />2220 - SM HW GEN <5 TONS/YR PR0513987 EE9999997 - TWO VACANT2 Inactive Y N A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE FE PR0509697 EE0000000 - HAZ MAT SJC OES Inactive Y N A I 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 also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State ancitor <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: $25.00 = Amount Paid Date / / <br />Water System to be TRANSFERED: Amount Paid Date / ! <br />Payment Type 1�Check Number Received b <br />EHD Staff: 'luie p Date 1i Account out:Date / L/ '/7L/ 9' <br />COMMENTS: Invoice* �'30rp2-D <br />/1 <br />���Q 21' <br />