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Date run 5/14/2003 8:01:21AN SAN JOIN COUNTY ENVIRONMENTAL,HEAL DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5114120 s <br /> Record Selection Criteria Facility ID FA0013339 <br /> Make changesicorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0010479 New Owner ID <br /> Owner Name TRIMARK COMMUNITIES <br /> Owner DBA <br /> Owner Address 3120 TRACY BLVD STE A <br /> TRACY, CA 95376 <br /> Home Phone 209-836-1560 <br /> Work/Business Phone 209-836-1759 <br /> Mailing Address 3120 TRACY BLVD STE A <br /> TRACY, CA 95376 <br /> Care of STANLEY PLOOF <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0013339 <br /> Facility Name TRIMARK/CHEVRON PIPELINE <br /> Location BYRON RD <br /> TRACY, CA 95376 <br /> Phone 209-836-1560 <br /> Mailing Address PO BOX 6012 <br /> SAN RAMON, CA 945830712 <br /> Care of PENNY T FOTTRELL <br /> Location Code APN: <br /> BOS District 005 - ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0022157 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility ! Account <br /> Account Name CHEVR�VIRONMENTAL MGMT CO (circ€e One) <br /> Account Balance as of 511412003: $0.00 <br /> {Circle <br /> Transfer to Actillnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? De ete <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PRO517323 EE0000684-MICHAEL INFURNA Active Y N A I) D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: [,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSlEHD hourly charges associate ith this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I atso certify that all operations will be performed in accordance with all applicable Ordinate Codes andlor Standards and <br /> State andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 / <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date 1 / <br /> Payment Type Check Number R ed y _ <br /> REHS: Date 5 1 Account ou Date <br /> COMMENTS: <br /> 1IPhs-ehsgl-ntlapps\EnvisionslReports15021.rpt <br />