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Date run 4/2/2009 10:29:49AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 4/2/2009 <br /> Record Selection Criteria: Facility ID FA0007030 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0005013 New Owner ID <br /> Owner Name VALLEY PACIFIC PETROLEUM SERV <br /> Owner DBA <br /> Owner Address 188 A FRANK WEST CIR <br /> STOCKTON, CA 95206 <br /> Home Phone 209-948-9412 <br /> Work/Business Phone 209-993-8793 <br /> Mailing Address 188-A FRANK WEST CIR <br /> STOCKTON, CA 95206 <br /> Care of VALLEY PACIFIC PETROLEUM SERV <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0007030 <br /> Facility Name VPPS 1004 <br /> Location 3550 S HWY 99 <br /> STOCKTON, CA 95215 <br /> Phone 209-948-9412 <br /> Mailing Address 188-A FRANKWESTCIR <br /> STOCKTON, CA 95206 <br /> Care of VALLEY PACIFIC PETROLEUM SERV <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 001 - GUTIERREZ, STEVE Fax <br /> APN 17916043 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MIKE ELIASON <br /> Title CARDLOCK MANAGER <br /> Day Phone 888-645-0020 <br /> Night Phone 209-993-8793 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0010115 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name VPPS1004 (Circle One) <br /> Account Balance as of 4/2/2009: $0.00 <br /> (Circle One) <br /> Transfer to Acthaulr ctve <br /> Program/Element and Descnptlon Record ID Employee ID and Name Status New Omen Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO517944 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512781 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PR0515566 EE0007289-ALISON YOUNGBLOODInactive Y N A I D <br /> 2361 -UST FACILITY PRO505827 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPRO507644 EE0007289-ALISON YOUNGBLOODInactive Y N A I D <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVEPRO515570 EE0008317-RAYMOND VON FLUE Active Y N AD <br /> 3123-STORMWATER INSPECTION-RETAIL GAS PR0527082 EE0008317-RAYMOND VON FLUE Active Y N A 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 associate with this <br /> facility 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 Ordinace Codes and/or Stan la s and <br /> State and/or Federal Laws. <br /> f t' q vJt`r`tW' <br /> APPLICANT'S SIGNATURE: Date <br /> ' /�/ T I <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / / <br /> Water System to be TRANSFERED: -*$372.00= Amount Paid Date <br /> Payment Type d Check Number Receiv <br /> REHS: ,{/,(,,,., Date _/�/� Account out: _ Date / /7_ (a <br /> COMMENTS: <br /> P <br /> \\eh-env\envision\reports\5021.rpt <br />