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Runby : SANDY San Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 12/30/98 <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date): <br /> OWNERSHIP CHANGE (date): <br /> OWNER ID: 005690 New Owner ID: 00 <br /> Owner Name: ARCO <br /> Owner DBA: <br /> owner Address: 4 CENTERPOINTE DR 300 <br /> LA PALMA, CA 90623 <br /> Home Phone: 408-259-4613 <br /> Soc sec# / Tax ID#: FED ID#51-012071 <br /> ownership Type: 01 CORPORATION <br /> Mailing Address: PO BOX 5079 <br /> care of: KYLE CHRISTIE <br /> BUENA PARK, CA 90622-5077 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007561 <br /> Facility Name: ARCO AM/PM <br /> Location: 2295 W GRANTLINE RD <br /> TRACY 95376 <br /> Phone: <br /> Mailing Address: 2295 W GRANTLINE RD <br /> Care of: ARCO <br /> TRACY, CA 95376 <br /> Location Code: APN: <br /> BOS District: SIC Code: <br /> ACCOUNTS RECEIVABLEFILE INFORMATION <br /> OWumor¢ )60, � 6a n) GAY D� <br /> ACCOUNT ID: 0012139 "New Account ID: 000 <br /> 4-�(y <br /> Mai L Invoices to: Account �� a'3� Mai L Invoices to: Owner / Facility / Account <br /> Account Name: SECOR INTERNATIONAL INC (Circle one) <br /> Account Balance as of 12/30/98 : $468 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> 2950 ENVIRON ASSESS PR506639 0997 KNOLL ACTIVE Y N A I D <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 facility or activity will be billed to the party identified as the <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 /> APPLICANTS SIGNATURE: Date / <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid Date-/-/ <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid Date <br /> Payment Type Check # Recvd by <br /> - - - - - - - - - - - - - - - - - - - - - - - - - <br /> - - - - - - - - - - - - - - - - - - -( -�- - -\- - - - - - - - - - - - - - - <br /> RENS or COUNTER SUPV: Date / - - - - <br /> / ACCT-out:- Date IST/vJi ) UNIT/File: / / <br />