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Dale run 12/28/2004 12:42:08I SAN JOIN COeeU��N�TY ENVIRONMENTAL HEA' DEPARTMENT Report#5021 <br /> Run by RE pffid Pagel <br /> C�f motion as of 12/28/21 <br /> Record Selection Criteria: Facility ID FA0006423 <br /> JAN 2 '1 ZUU5 Make changeslcorrections in RED ink or pencil. <br /> SAN JOAQUIN COUNTY INFORMATION CHANGE(date) <br /> ENVIRONMENTAL OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION HEALTH DEPARTMENT <br /> Owner ID OW0005463 Ne er I <br /> Owner Name `VEH ^" '� ° ^' �""-"`� e 2 <br /> vvac�c-lvn"crT-arArvrrvrrTv�IvcY �e <br /> Owner DBA UNITED GAS LkAA t4)—e4GaS <br /> Owner Address 15814 WINCHESTER BLVD 103 (85; J)• FL /�✓E <br /> LOS GATOS, CA 95030 Lis., 9 1 CA 4 `VO2'Z <br /> Home Phone Not Specified50 - 17,11 - s <br /> Work/Business hone -a <br /> dDAaa 130 -. _. __ Z "'( ?1 6 <br /> ailiNY ngAddre 15814 WINCHESTER <br /> ^ r OTOS CA 95030 __ — pil ' e <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0006423 <br /> Facility Name UNITED GAS <br /> Location 3440 E MAIN ST <br /> STOCKTON, CA 95205 <br /> Phone 209=463.714& Zc L(63 - -7-7 ( C� <br /> Mailing Address 3440 E MAIN ST <br /> STOCKTON, CA 95205 <br /> Care of Teo yule e <br /> Location Code 01 -STOCKTON P <br /> BOS District 002-MARENCO, DARIO SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION ('p�Mr� MED <br /> Account ID AR0009105 Ifs] L� V NewAccount ID: <br /> Mail Invoices to Facility DEC 2 9 2004 Mail Invoices to: Owner / cili / Account <br /> Account Name UNITED GAS (c � one) <br /> Account-Balance as of 12/28/2004: $170.00 ENVIRONMENT HEALTH <br /> PERMIT/SERVICES (Circle One) <br /> Transfer to gcMe/Inaclve <br /> Naw Owner? Delete <br /> Program/Element and Description Record ID Employee ID and Name Status <br /> 1615 RETAIL MKT<2000 SOFT (PREPKGD/LTOPRO161544 EE0003474-CHANDRA OM Active Y N A 1 D <br /> 2220-SM HW GEN<5 TONS/YR PRO518582 EE0008373-JOHN JACKSON Active Y N A 1 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512638 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO521208 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2301 -UST STATE SURCHARGE PR0507753 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> ,4361 -NEW MULTI UST FACILITY PR0231173 EE0008373-JOHN JACKSON Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0507625 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0518584 EE0008389-DENNIS CATANYAG 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 speck,PHS/EHD hourly charges associated with this <br /> facility or act ly will be billed to the party identified as the OWNER on this form. I also candy that all operations will be performed in accordance with all applicable 99rdinace Codes and <br /> 1/o <br /> /'r Standardsand <br /> Slate and/or Federal Laws. qr/l/ L9�G�y.6 <br /> APPLICANTS SIGNATURE: _ �'a' /I A.l�— Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid17�Date /_92'2_/Loj,A-DY)57 E rrD/olU <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date 441 /_ )14 ;�b b G 5 <br /> Payment Type Check Number 9.2(9 _Received byn <br /> RENS: 73 Date /Z / / .y vAccount out: XkDate <br /> COMME <br /> FDrp Tk >Ywtr 11 t 1P _PRI <br /> \\phs-ehsql-ntWpps\en inion'\rep r s\5 21.rpt <br />