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[Run <br /> ate ran 6/7/2013 3:41:13PM SAN JOIN COUNTY ENVIRONMENTAL HEAD DEPARTMENT <br /> by Report#5021 <br /> Facility Information as of 6/7/2013Pagel <br /> ecortl Selection Criteria: Facility ID FA0021555 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0003627 New Owner ID <br /> Owner Name CALIFORNIA WATER SERVICE CO <br /> Owner DBA <br /> Owner Address 1720 N FIRST ST <br /> SAN JOSE, CA 95112 <br /> Home Phone 800-750-8200 <br /> Work/Business Phone 209-464-8311 <br /> Mailing Address 1720 N FIRST ST <br /> SAN JOSE, CA 95112 <br /> Care of ACCOUNTS PAYABLE <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0021555 <br /> Facility Name CALIFORNIA WATER SERVICE <br /> Location 141 S CARDINAL AVE <br /> STOCKTON, CA 95215 <br /> Phone 209-547-7900 <br /> Mailing Address 1720 N FIRST ST <br /> SAN JOSE, CA 95928 <br /> Care of ACCOUNTS RECEIVABLE <br /> Location Code Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 15919215 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ROSS MOILAN <br /> Title <br /> Day Phone 209-547-7900 <br /> Night Phone 209-547-7910 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0039021 New Account ID: <br /> Mail lnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CALIFORNIA WATER SERVICE (Circle One) <br /> Account Balance as of 6/7/2013: $0.00 <br /> (Circle One) <br /> Transfer to Activellnectve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1925-HMBP-Multisite Secondary Location PR0537472 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,andor protect spacdc,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ands <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br />