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run 10/11/2005 9:33:02A SAN JOA IN COUNTY ENVIRONMENTAL HEAL BEPARTMENT Report#5021 <br /> in by E~�/ <br /> Facility Information as of 10/11/2005 Pagel <br /> Record Selection Criteria: Facility ID FA0006825 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0012871 New Owner ID <br /> Owner Name CONOCOPHILLIPS CO DBA KAYO OIL <br /> Owner DBA 76 STATION 2787245 <br /> Owner Address 315 S JOHNSTONE RM 810-G <br /> BARTLESVILLE, OK 74004 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 3611 HARBOR BLVD STE 200 <br /> SANTA ANA, CA 92704 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0006825 <br /> Facility Name 76 STATION 2787245 <br /> Location 1206 E MARCH LN <br /> STOCKTON, CA 95210 <br /> Phone <br /> Mailing Address 1206 E MARCH LN <br /> STOCKTON, CA 95210 <br /> Care of CONOCO PHILLIPS <br /> Location Code 01 - STOCKTON APN:10416004 <br /> Bos District 002 - MARENCO, DARIO SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0009459 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility 1 Account <br /> Account Name CONOCO PHI S (Circle One) <br /> Account Balance as of 1011112005: 0✓ <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name StatuYe New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0505510 EE0000684-MICHAEL INFURNA Ac e 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.PHSlEHD hourly charges associated with this <br /> facility or activitywill 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 Ordinace Codes and/or Standards and <br /> State andlor Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$20.00= Amount Paid Date / 1 <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date I / <br /> Payment Type Check Number Re cei _ <br /> REH& Date I(Q1 l 1 Account out: _ Date�l f7 I_K1 <br /> COMMENTS: <br /> 11phs-ehsgl-ntlappslenvisionslreports15021.rpt <br />