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Date run 5/20/2015 4:22:39PR SAN JOA 'IN COUNTY ENVIRONMENTAL HEAL' DEPARTMENT Report r5021 <br /> Run by `l Pagel <br /> Facility Information as of 5/20/201? <br /> Record Selection Criteria. Facility ID FA0021580 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 6 SSN/Fed Tax ID <br /> Owner ID OW0002112 New Owner ID <br /> Owner Name San Joaquin Delta College <br /> Owner DBA <br /> Owner Address 5151 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Home Phone 209-954-5385 <br /> Work/Business Phone 209-954-5385 <br /> Mailing Address 5151 Pacific Ave <br /> Stockton, CA 95207 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021580 10500955 <br /> Facility Name San Joaquin Delta College South Campus at A <br /> Location 2073 S CENTRAL PKWY <br /> Mountain House, CA 95391 <br /> Phone 209-954-6043 x <br /> Mailing Address 5151 Pacific Ave <br /> Stockton, CA 95207 <br /> Care of San Joaquin Delta College, Thomas Tuzinows <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> Bos District 005 - ELLIOTT, BOB Fax <br /> APN 209.080.34 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0039079 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name San Joaquin Delta College (Clyde One) <br /> Account Balance as of 5/20/2015: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inadve <br /> Program/Element and Description Record ID Employee ID and Name Stews New Owner? Delete <br /> 1920-HMBP-Common Materials PRO539966 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO537504 EE0002646-THUY TRAN Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,andar project specific,PHSEHD hourly charges assodated 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 ardor Standards antl State andor <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 /> EHD Staff: Date / / Account out: Date / / <br /> COMMENTS: <br /> Invoice#: <br />