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Date run 1/5/2015 11:37:33AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENTReport#5021 <br /> Run by Pagel <br /> Facility Information as of 1/5/2015 <br /> Record Selection Criteria_ Facility ID FA0022727 <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 : SSN 1 Fed Tax ID <br /> Owner ID OW0020480 New Owner ID <br /> Owner Name California Water Service Company <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 408-367-8200 <br /> Mailing Address 1720 North First St. <br /> San Jose, CA 95112 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0022727 10480120 <br /> Facility Name California Water Service Co. - STK 36 <br /> Location 4213 N Commerce St <br /> Stockton, CA 95204 <br /> Phone 209-547-7900 x <br /> Mailing Address 1602 E. Lafayette St. <br /> Stockton, CA 95205 <br /> Care of California Water Service Company <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0041637 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner J Facility 1 Account <br /> Account Name California Water Service Company (Circle One) <br /> Account Balance as of 11512015: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO539725 EF0009817-ROBERT LOPEZ Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWL€DGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSIEHD 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 and/or Standards and State arlsor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received by <br /> REHS l Date 1 -__/ I t Account out: Date�l �! <br /> 15L— <br /> COMMENTS <br />