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Run by : STAFF .Sar-t-Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 06/18/98 <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: 000771 New Owner ID: 00 <br /> Owner Name: MCCARTHY, JIM <br /> Owner DHA: YOSEMITE 76 MART l <br /> Owner Address: 76 BROADWAY <br /> SACRAMENTO, CA 95330 <br /> Home Phone: 209-823-7676 <br /> See Sec# / Tax ID#: l <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: YOSEMITE 76 MART i <br /> Care of: 1700 E YOSEMITE AVE <br /> MANTECA, CA 95336 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 007765 <br /> Facility Name: TOSCO MARKETING CO (UNOCAL/TOSCO) <br /> Location: 1700 E YOSEMITE AVE <br /> MANTECA 95336 <br /> Phone: 209-823-7676 <br /> Mailing Address: 650 HOWE AVE #504 <br /> care of: RHL DESIGN GROUP <br /> SACRAMENTO, CA 95825 Z Ln <br /> Location Code: APN: COW fit U <br /> r I y <br /> HOS District: SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0013827 New Account ID: 000 <br /> Mail Invoices to: Facility Maill Invoices to: Owner / Facility / Account <br /> Account Name: TOSCO MAR ING CO CAL/TOS (Circle one) <br /> Account Balance as of 0 6/1$/9 8 : 0n+� (Circle on <br /> Record /1 1 e) <br /> UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Emplo Status Linked new owner? Delete I <br /> ---------- o <br /> ------------------------------- <br /> 29- ENVIRON ASSESS --PR- - 1--- ----- ACTIVE-- Y N A 0 D <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 ac ivity 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 /> ---------------------------------------------L--------------------------------- <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 Chelck # Recvd by <br /> RENS or COUNTER SUPV: Dat / / ACCT out: Date / _.r /�� UNIT/File; <br /> s <br />