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Date run 1/18/2017 8:18:59AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 1/18/2017 <br /> Record Selection Criteria: Facility ID FA0022965 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: SSN/Fed Tax ID <br /> Owner ID OW0020987 New Owner ID <br /> Owner Name AMERICAN TOWERS - EH&S Dept. <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 602-999-5139 <br /> Mailing Address 10 Presidential Way <br /> Woburn, MA 01801 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0022965 10630189 <br /> Facility Name AMERICAN TOWERS- LOCKEFORD CA-SIT <br /> Location 14700 E HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Phone 602-999-5139 x <br /> Mailing Address 10 Presidential Way <br /> Woburn, MA 01801 <br /> Care of AMERICAN TOWERS- LOCKEFORD CA- SIT <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 AR0042123 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name AMERICAN TOWERS - EH&S- SITE#8303 - LOCKE (Circle One) <br /> Account Balance as of 1/18/2017: $0.00 <br /> (Circle One) <br /> Transferto Active/Inactve <br /> (ro ment and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1 21 -HMBP-Regular-Primary Location PR0540168 EE0008709-JAMIE LIMA Active Y N A I D <br /> LLING 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 or <br /> 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 andror 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 Ty Check Number Received <br /> EHD Staff: TSI OA Date / / Account out: Date /��/ Z <br /> COMMENTS: <br /> Ir1VOICe#: <br /> CX MM OAM �d <br />