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Date run x/14/2014 8:11:42An SAN JO UIN COUNTY ENVIRONMENTAL HEAI'�[DEPARTMENT <br /> Report#5021 <br /> Rurzy L,/ Pagel <br /> Facility Information as of 2114/2014 <br /> Record Selection Criteria Facility ID FA0022140 <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 OW0009900 New Owner ID <br /> Owner Name AMERICAN TOWERS <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 P.O. BOX 63604 <br /> PHOENIX, AZ 85082 <br /> Care of SCOTT SANDEFUR <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0022140 10,406,626 <br /> Facility Name AMERICAN TOWER PETERS#40907 <br /> Location 791 DRAIS RD <br /> STOCKTON, CA 95215 <br /> Phone 602-284-0280 <br /> Mailing Address PO BOX 63604 <br /> PHOENIX, AZ 85082 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004-VOGEL, KEN Fax <br /> APN 18321014 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 AR0040360 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name AMERICAN TOWER PETERS#40907 posts One) <br /> Account Balance as of 2/14/2014: $0.00 <br /> (Circle One) <br /> Transfer toActivadnachve <br /> Progran✓Element and Description Record ID Employee ID and Name Status New Owner? tete <br /> 1926-HMBP-Unstaffed Network Location PRO538296 EE0008709-JAMIE DE LA ROSA Active,l 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 billed to the party Identified as the OWNER on this form. I also certify that all operations will be patterned in accordance with all applicable Ordinance Codes andor Standards and State ander <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 Tye Check Number Receiv <br /> REHS: <br /> Payment Check <br /> Date Lt/ JL4 Account out: Date C? / / <br /> COMMENTS: <br />