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r <br /> h Run by STAFF SjI'Joaquin County PHS/EHD Report #5021 <br /> FACILITY. INFORMATION as of08/13/99 <br /> ------------=- ---- ----- ------- - - ------------ -- - -------- ---- --- ----- --------- ----- <br /> Make changes/corrections in RED pen or pencil: <br /> F OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: 006.569 New Owner ID: 00 <br /> Owner Name: DOBLER, LOUIE. - <br /> Owner DBA: - <br /> Owner Address: 276 W 20TH ST <br /> TRACY, CA 9537.6 <br /> Home phone: 209-836--3316 <br /> Sac sec# / Tax ID#: SS#549-44-$690 CONFIDENTIAL., <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: 276 W 20TH ST <br /> Care of!, <br /> TRACY, ' CA 95376 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007948 <br /> Facility Name: DOBLER, LOUIE <br /> Location: 13588 W GRANT LINE <br /> TRACY 95376 <br /> Phone: <br /> Mailing Address: 276 W 20TH ST <br /> care of: LOUIE DOPLER <br /> TRACY, CA 95376 <br /> Location Code: APV: <br /> BOS District: 005 SIC Code: - <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0014708 New Account ID: 000 <br /> II Mail Invoices to: Account Mail Invoices to: Owner / Facility / ACCount <br /> ' Account Name: CHEVRON PIPELINE CO <br /> (Circle one) <br /> Account Balance as of 08/13/99 : $0 . 00 <br /> {Circle one} <br /> Record' UST(s) Transfer to Activate / Inactivate <br /> i P/E Description ID Employee Status ` Linked new owner? Delete <br /> i <br /> j -- -------------- ----- ----- - ---------------------- ------- ----- ---- --`//---///- ----- ---- <br /> 2950 ENVIRON ASSESS PR508113 0684 INPURNA ACTIVE Y N A D <br /> 12 <br /> ----- -------- ------ ------ ------- -------------- ------- ----- ------ ----- --- <br /> -- <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> project specific PHS/EHD hourly charges associated with this"'€acility or activity will be billed to the party identified as the <br /> r <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: pate <br /> PR Records to be TRANSFERED: x $20.00 Amount Paid Date <br /> Water System to he TRANSFERED: x $150.00 = Amount Paid Date / <br /> Payment Type Check # Recvd by <br /> --------------- <br /> ----- - - --I-�------ - - --------„---- --p--- - ----- ---- ------ - - - <br /> REHS or COUNTER SUPV: bate / "J/ ACCT out: Date C/U / �� /9 UNIT/File:-/-/ <br /> r <br /> i <br />