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[Run <br /> te mn 9/8/2014 4:25:07PM SAN JO��UIN COUNTY ENVIRONMENTAL HEA! I DEPARTMENT rtwort tlsort <br /> byFacility Information as of 9/8/2014rP°0°' <br /> ord Selection Criteria: Facility ID FA0021367 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 32 SSN/Fed Tax ID <br /> Owner ID OW0009900 New Owner ID <br /> Owner Name American Tower <br /> Owner DBA AMERICAN TOWER <br /> Owner Address PO BOX 63604 <br /> PHOENIX, AZ 850823604 <br /> Home Phone 602-284-0280 <br /> Work/Business Phone 602-284-0280 <br /> Mailing Address PO Box 63604 <br /> Phoenix, AZ 85082 <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 Aft Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 10222021 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 AR0038732 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name AMERICAN TOWER CORP (Clyde One) <br /> Account Balance as of 9/8/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/InaMe <br /> Program/Element and Description Rewrd ID Employee ID and Name Status New Owner? Delete <br /> 1926-HMBP-Unstaffed Network Location PR0537239 EE0000006-HAZA SAEED 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 project specific.PHSIEHD hourly charges associated with this facility <br /> or activity will be billetl to the party identified as the OWNER on this form. I also wady that all operations will be performed in accordance with all applicable Oodussoca Codes andor Standards and State andor <br /> 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 /> REHS: Date / /_ Account out: Date <br /> COMMENTS: <br />