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51ate run? 8/22100 12:41:37PM ' 1N JOAQUIN COUNTY PUBLIC HEALTI tRVICES Report #: 0002 <br />Run by : VDAVIS �... Facility Information as of 6/22/06—*' Page #: 1 <br />Record Selection Criteria: Facility ID FA0009702 <br />Record ID <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />OWNER FILE INFORMATION <br />Owner ID: OW0007702 Case Number. H05136 New Owner ID <br />Owner Name: PG&E <br />Owner DBA <br />Owner Address: <br />Home Phone: Not Specified <br />WorkBussness Phone; 415-973-7000 <br />Mailing Address: PO BOX 770000 <br />Care of: <br />FACILITY FILE INFORMATION <br />Facility ID: FA0009702 <br />FacilityName: PG&E WATERLOO SUBSTATION <br />Locations -Q800 N ALPINE RD <br />%CKTON, CA 95121 20 6J ,J <br />Phone: 209-843-5013 <br />Mailing Address: PO BOX 671 <br />Care of: PG&E/CLIFF SEVERSON <br />Location Code: APN; 089-020-43 49 <br />BOS District. SIC Code: <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />AccountlD: AR0016702 New Account ID:: <br />Mall Invoices to: Account Mail Invoices to: Owner / Facility / Account <br />Account Name: PG&E J (Circle One) <br />Account Balance as of 6/22/00: $10.0 <br />(Circle One) <br />UST(s) Transferto Active/Inactv <br />Program/Element and Description Record ID Employee ID and Name Status Linked New Owner? Delete <br />2226 - Ca1ARP PROGRAM PRO514652 EE0000000 - SJC OES Active Y N 1 <br />2399 - UNIFIED PROGRAM FAC STATE SERVICE F PRO509702 EE0000000 - SJC OES Active Y N 1 \ <br />2220 - SM HW GEN <5 TONSNR PRO513992 EE0006213 - PEDRAZA Active Y N <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO511990 EE0o00000 - SJC OES Active y N I <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT. • I, the undersigned owner, operator or a&ent of -same, acknowledge that all site, and/orprol'ect <br />specific, PHSIEIID hourly char. -es associated with this facility or activity will be billed to the party identr red as the BILLING PARTYon thisform I <br />also certify that aB operations wrB be performed in accordance with allapplicable Ordinate Codes an or Standards and State and/or Federal Laws. <br />APPLICANT'S SIGNATURE: <br />M new1us ro ue i R Narmmmu: - au.uu = <br />System to be TRANSFERED: . $150.00 = <br />int Type Check Number <br />Date <br />1.0.0.69.00 <br />Date I / <br />_ Amount Paid Date /I_ <br />Receipt NumberReceived by <br />/ Account out: Date <br />