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Date run 3/9/2011 8:57:03AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/9/2011 <br /> Record Selection Criteria: Facility ID FA0016627 <br /> Make changes/corrections in RED ink. <br /> PA <br /> ® INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002957 New Owner ID <br /> Owner Name PG&E &CO <br /> Owner DBA PG&E <br /> Owner Address 3401 CROW CANYON RD RM 176C <br /> SAN RAMON, CA 94583 <br /> Home Phone 925-415-6381 <br /> Work/Business Phone 925-415-6371 <br /> Mailing Address 3401 CROW CANYON RD RM 176C <br /> SAN RAMON, CA 94583 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0016627 <br /> Facility Name PG&E FRENCH CAMP YARD <br /> Location 401 E FRENCH CAMP RD <br /> FRENCH CAMP, CA 95231 <br /> Phone <br /> Mailing Address 77 BEALE ST <br /> SAN FRANCISCO, CA 94105 <br /> Care of PG&E FRENCH CAMP YARD <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 19314013 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name TERRY R WINSOR <br /> Title PROJECT MANAGER <br /> Day Phone 415-973-1284 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0029414 � New Account ID: <br /> Mail Invoices to Account n /l�I V Mail Invoices to: Owner / Facility ! Account <br /> V (Circle One) <br /> Account Name PG&2011: -122.0 0 o/� <br /> Account Balance as of 3/9/2011: $-122,.�00/) °Jt �, <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name atus New Owner? D ete <br /> 2960-RWQCB SITE PR0524769 EE0000684-MICHAEL INFURNA Active Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,a ject specific,PHS/EHD hourly charges associa with this <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to a TRANSFERED: '$25.00= Amount Paid Date <br /> Water System be T ANSF RED: Amount Paid Date <br /> Payment Ty Check Number Received by _ <br /> REHS: Date / / Account out: _� Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />