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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#51-012 0 71 <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: 2470 W GRANTLINE RD aaRS (7Ya�#'Cuc,C� <br /> TRACY 95376 <br /> Phone: <br /> Mailing Address: 2470 W GRANTLINE RD <br /> Care of: ARCO <br /> TRACY, CA 95376 <br /> Location Code: APN: r� 1 <br /> BOS District: SIC Code: x-QiL <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0012139 New Account ID: 000 <br /> Mai L Invoices to: Account Mai L Invoices to: Owner / Facility / Account <br /> Account Name: SECOR INTERNATIONAL INC (circle one) <br /> Account Balance as of 05/20/98 : $0 . 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 /> APPLICANT'S SIGNATURE: Date <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <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 /> REHS or COUNTER SUPV: Date—/—/ ACCT out:— Lb Date 051 v;k(p UNIT/File: / / <br />