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mete run 9/13/2012 2:49:47PA SAN JO UIN COUNTY ENVIRONMENTAL HEAT DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 9/13/20 IL <br />Record Selection Criteria: Facility ID FA0018394 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0015113 <br />Owner Name <br />VALLEY PACIFIC PETROLEUM SERVI <br />Owner DBA <br />VALLEY PACIFIC PETROLEUM SERVI <br />Owner Address <br />188 A FRANK WEST CIR <br />Phone <br />STOCKTON, CA 95206 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209--94-8-94 <br />Mailing Address <br />166 FRANK WEST CIR <br />STOCKTON, CA 95206 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0018394 <br />Facility Name <br />VALLEY PACIFIC PETROLEUM SVC INC <br />Location <br />1524 FRESNO AVE <br />STOCKTON, CA 95206 <br />Phone <br />209--99-3-87 x0 <br />Mailing Address <br />166 FRANK WEST CIR <br />STOCKTON, CA 95206 <br />Care of <br />Location Code <br />BOS District <br />APN 16337027 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0032441 <br />Mail Invoices to Owner <br />Account Name VALLEY PACIFIC PETROLEUM SERVI <br />Account Balance as of 9/13/2012: $0.00 <br />Program/Element and Description Record ID Employee ID and Name <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID <br />Alt Phone <br />Fax <br />EMail : <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/lnactve <br />Status New Owner? Delete <br />1926 - HMBP-Unstaffed Network Location PR0527135 EE0009817 - ROBERT LOPEZ Active Y N A U 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 andlor <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 Check Number Receb y <br />REHS: `N . Date Account out: Date <br />COMMENTS: <br />