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Data run 10/2112014 11:31:58/ SAN JO IN COUNTY ENVIRONMENTAL HEALORepnrt#5021DEPARTMENT pager <br /> Run by <br /> Facility Information as of 1012112014 <br /> Record Selection Criteria: Facility ID FA0006423 <br /> Make changeslcorrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSNIFed Tax ID : <br /> Owner ID OW0005463 New Owner ID <br /> Owner Name LEE, JEAN HYUN <br /> Owner DBA <br /> Owner Address 185 N EL MONTE AVE <br /> LOS ALTOS, CA 94022 <br /> Home Phone 605-941-1852 <br /> Work/Business Phone 650-941-1852 <br /> Mailing Address 185 N EL MONTE AVE <br /> LOS ALTOS, CA 94022 <br /> Care of LEE, JEAN HYUN <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility lD/CERS ID FA0006423 10182099 <br /> Facility Name UNITED GAS <br /> Location 3440 E MAIN ST <br /> STOCKTON, CA 95205 <br /> Phone 209-463-7716 x <br /> Mailing Address 3440 E MAIN ST <br /> STOCKTON, CA 95205 <br /> Care of LEE, Kyung-il <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 15716002 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JEAN HYUN LEE <br /> Title <br /> Day Phone 209-463-7716 <br /> Night Phone 650-941-1852 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0009105 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name UNITED GAS (Cirde One) <br /> Account Balance as of 10/21/2014: $0.00 <br /> (Circle One) <br /> Transfer to Activellnedve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1615-RETAIL MKT 301-2000 SO FT(PREPKGD/LTD PF PR0161544 EE0008999-LEYNA HUYNH Active Y N A I D <br /> 1920-HMBP-Common Materials PRO521208 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO518582 EE0009488-JEFFREY WONG Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512638 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PRO507753 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2361 -UST FACILITY PR0231173 EE0009488-JEFFREY WONG Active Y N A 1 D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0507625 EE0000008-LETITIA BRIGGS Inactive Y N A 1 D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0518584 EE0001422-ARIS VELOSO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533195 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 Ne OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ands <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date_/_/ Account out: Date <br /> COMMENTS: <br />