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Date run 9/29/2010 2:47:49Ph SAN J a UIN COUNTY ENVIRONMENTAL HE,1H DEPARTMENT Report#5021 <br /> Run by Facility Information as of 9129/2010 Pagel <br /> Record Selection Criteria: Facility lD FA0018683 <br /> Make changes/corrections in RED ink. <br /> i INFORMATION CHANGE(date) <br /> C. <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION ,(. SSN!Fed Tax iD <br /> Owner ID OW0015354 ��� New Owner ID <br /> Owner Name STOC ASSOCIATES LLC \ <br /> Owner DBA LEXINGTON PLAZA WTRFRONT HOTEL <br /> Owner Address 110 W FREMONT ST <br /> STOCKTON, CA 95202 <br /> Home Phone 209-944-1140 <br /> Work/Business Phone Not Specified <br /> Mailing Address 900 UNIVERSITY AVE STE 200 <br /> SACRAMENTO, CA 958255737 V au <br /> Care of LEXINGTGON PLAZA HOTEL 2010 <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0018683 (4 J0+ QUI <br /> Facility Name LEXINGTON PLAZA WATERFRONT HOTEL CS <br /> Location 110 W FREMONT ST <br /> STOCKTON, CA 95202 <br /> Phone 209-944-1140 <br /> Mailing Address 1860 HOWE AVE STE 440 '04V40., STE d 3 D O <br /> -SACRAMENTO, CA 958251098 P171t- D <br /> Care of REGENT HOTEL 'TOG rcoUla7E1' 1.1_C <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 13741012 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name STOC ASSOCIATES LLC <br /> Title <br /> Day Phone 209-944-1140 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0033107 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility Account <br /> Account Name LEXINGTON PLAZA WATERFRONT HOTEL utaone) <br /> Account Balance as of 912912010: $347.00 <br /> {Circle One} <br /> Transfer to Active/lnactve <br /> ,2!Ment and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1$2 STAURANTIBAR 101 +SEATS PRO527574 EE0003474-CHANDRA OM Active Y N A I D <br /> 244-PACT TRANSFER RECORD-OES PRO531235 Active Y N A I D <br /> 2409-HOTEL/MOTEL>90 PR0527575 EE0002424-ROCHELLE VELOSO-C)Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO531956 Active 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.PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the party Identified as the OWNER on this form. 1 also certify that all operations will be performed in accordance with all applicable Ordinace Codes andlor Standards and <br /> State andlor Federal Laws. <br /> APPLICANTS SIGNATURE: S 2 � Q CAS Date 1. I Z�1 X u <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date ! ! <br /> Water System to be TRANSFERED; Amount Paid Date ! 1 <br /> Payment Type Check Number Received by <br /> REHS: Date 00f / ?A ! I o Account out: l�'Tr_ Date <br /> COMMENTS: 10 <br />