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Run by : NORA SO- Joaquin County PHS/EHD • Report #5021 <br /> FACILITY INFORMATION as of 10/28/97 <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date): <br /> OWNERSHIP CHANGE (date): <br /> OWNER ID: 002758 New Owner ID: 00 <br /> owner Name: PORT OF STOCKTON <br /> Owner DBA: <br /> owner Address: 2526 W WASHINGTON ST <br /> STOCKTON, CA 95203 <br /> Home Phone: <br /> Soc Sec# / Tax ID#: <br /> ownership Type: 01 CORPORATION <br /> Mailing Address: 2526 W WASHINGTON ST <br /> care of: PORT OF STOCKTON <br /> STOCKTON, CA 95203 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 004011 <br /> Facility Name: PORT OF STOCKTON-FUEL TERMINAL <br /> Location: NAVY/WASHINGTON <br /> STOCKTON 95203 <br /> Phone: 213-486-1293 <br /> Mailing Address: ��-BDX�689 ��W �✓�'-+"'c� <br /> Care of: murrnT emnrumnnr m�ngl n /�Ol C? { j <br /> Location Code: 01 APN: <br /> BOS District: SIC Code: �hQ�e yL6- u y L� <br /> ACCOUNTS RECEIVABLE FIL ' INFORMATI ;17,4W 0 <br /> St Firh.�.-,, Co gsao3 <br /> ACCOUNT ID: 0003641 �'� New Account ID: 000 <br /> Mail Invoices to: Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name: PORT OF STO TON-FUEL TERMINAL (circle one) <br /> Account Balance as of 10/28/9' : 24 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description - - ID- - - �mpfoyee ,/, - - Status - Linked -new owner?- - - Delete - - - <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Irk YnNn�'`X/ <br /> 2960 RWQCB CLEAN UP SITE - - PR009171 - - - - L-ABBRIO - - ACTIVE- - _ - - Y - N I D <br /> BILLING and COMPLIANCE ACKNOWLED ENT: I, the dersigned owner, operator or agent of same, acknowledge that all site and/or <br /> project specific PHS/EHD hourly charges crated 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 <br /> ate_/ /Water System to be TRANSFERED: x $150.00 = Amount Paid Date— <br /> Payment Type Check # Recvd by <br /> RENS or COUNTER SUPV. DatgL6 /(21y /77ACCT out: Date 10/171?z� /2Z UNIT/File:_/_/_ <br /> �o(` <br /> �1 <br />