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E <br /> n 12/22/2016 1:59:49P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Facility Information as of 12/22/2016 Pagel <br /> Selection Criteria: Facility ID FA0021367 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) �a— <br /> OWNER FILE INFORMATION Number of facilities for this owner: 32 <br /> SSN/Fed Tax ID <br /> Owner ID OW0009900 New Owner ID <br /> Owner Name AMERICAN TOWERS - EHBS Dept. <br /> Owner DBA AMERICAN TOWER <br /> Owner Address 10 PRESIDENTIAL WAY <br /> WOBURN, MA 01801 <br /> Home Phone 602-284-0280 <br /> Work/Business Phone 602-999-5139 <br /> Mailing Address 10 Presidential Way <br /> Woburn, MA 01801 <br /> Care of SCOTT SANDEFUR <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021367 10187821 <br /> Facility Name AMERICAN TOWER CORP <br /> Location 4910 CLAREMONT AVE <br /> STOCKTON, CA 95207 <br /> Phone 916-364-8190 <br /> Mailing Address PO BOX 63604 <br /> PHOENIX,AZ 85082-3604 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 002 - MILLER, KATHERINE Fax <br /> APN 10222021 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION �/y Ww l 'V I L <br /> Contact Name (NJ -- <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0038732 New Account ID <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name AMERICAN TOWER CORP (Chale One) <br /> Account Balance as of 12/22/2016: $0.00 <br /> (Circle One) <br /> Transfer to Acfiy,Mnactve <br /> Program/Element and DescriptionRecord ID Employee ID and Name Status New OwnAO We <br /> 1920-HMBP-Common Materials PRO537239 EE0000006-HAZA SAEED Active Y N U:ND <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undenigned owner operator or agent of same,acknowledge that all site,anclor project specfc,PHSIEHO hourly charges associated with Mm <br /> facility or activity will be billed to the party identified as the OWNER on due form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes anaVor Standards <br /> and State anctor Federal Laws. <br /> APPLICANTS 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�'z`/�-t /� Account out: Date / Z-3 / /L <br /> COMMENTS: <br /> Invoice#: <br /> T vra - �� 'u�a� 'mss yoW � Ate, io <br /> '�ia Y) � <br />