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Date run 10/22/2018 2:49:00P SAN JOAQUIN COUNT' ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by - Pagel <br /> Facility Information as of 10/22/2018 <br /> Record Selection Criteria: Facility ID FA0009872 <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: 4 SSN/Fed Tax ID <br /> Owner ID OW0011475 New Owner ID <br /> Owner Name Pacific Bell Telephone Company dba AT&T C� <br /> Owner DBA AT&T California <br /> Owner Address 2600 CAMINO RAMON 3E000 <br /> SAN RAMON, CA 945830995 <br /> Home Phone Not Specified <br /> Work/Business Phone 214-464-1712 <br /> Mailing Address 308 S. Akard St., 17th Floor <br /> Dallas, TX 75202 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009872 10207009 <br /> Facility Name AT&T CALIFORNIA- UE018 <br /> Location 13585 E HWY 88 <br /> Lockeford, CA 95237 <br /> Phone 209-603-9726 x <br /> Mailing Address 308 S. Akard St., 17th Floor D/ Xliu-�7 ✓C P4A) <br /> Dallas, TX 75202 ML4<A4. YLI n 6t'- �f S <br /> Care of AT&T California <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 004 -WINN, CHARLES 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 AR0016872 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name AT&T CALIFORNIA- UE018 (Circle One) <br /> Account Balance as of 10/22/2018: $641.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0512160 EE0008709-JAMIE LIMA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0539193 EE0000030-AARON HANG Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509872 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0528921 EE0000030-AARON HANG InactivE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific.PHS/EHD 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 and/or <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 b <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> Invoice#: <br />