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Date run 12/21/2015 1:59:22F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 Run by Pagel Facility Information as of 12/21/2015 Record Selection Criteria: Facility ID FA0010925 OWNER FILE INFORMATION Number of facilities for this owner Owner ID OW0008925 Case Number: H08982 Owner Name OUTFRONT MEDIA Owner DBA CBS OUTDOOR SACRAMENTO OFFICE Owner Address 2050 W FREMONT ST STOCKTON, CA 95203 Home Phone Not Specified Work/Business Phone 973-575-6900 Mailing Address PO BOX 404 BROADWAY, NJ 08808-0404 Care of FORREST PORTER FACILITY FILE INFORMATION Facility ID / CERS ID FA0010925 10183939 Facility Name OUTFRONT MEDIA STOCKTON OFFICE Location 2050 W FREMONT ST STOCKTON, CA 95203 Phone 209-466-5022 x Mailing Address PO BOX 404 BROADWAY, NJ 08808-0404 Care of FORREST PORTER Location Code 01-STOCKTON BOS District 001 - VILLAPUDUA, CARLOS APN 13336046 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Forrest Porter Title Operations Manager Day Phone 209-466-5021 Night Phone 209-649-3174 ACCOUNTS RECEIVABLE FILE INFORMATION Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN /Fed Tax ID New Owner ID : Alt Phone Fax EMail : Account ID AR0017925 New Account ID: : Mail Invoices to Account Mail Invoices to: Owner / Facility / Account Account Name OUTFRONT MEDIA (Circle One) Account Balance as of 12/21/2015: $0.00 (Circle One) Transfer to Active/Inactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 1921 - HMBP-Reqular-Primary Location PRO520553 EE0009817 - ROBERT LOPEZ Active Y N A10 DD 2220 - SM HW GEN <5 TONS/YR PR0514454 EE0001421 - STACY RIVERA Active Y N A I D 2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR0513213 EE0000000 - HAZ MAT SJC OES InactivE Y N A I D 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510925 EE0000000 - HAZ MAT SJC OES InactivE Y N A I D ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0533531 InactivE Y N A I D 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 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 anc/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received b EHD Staff: Date l Z / Z 1 / _ Account out: � Date 12- 12,1 / IS COMMENTS: Invoice #: am/j% R L t / l �1t S ' i n / : v �Z .9t1'/,2 /)- v e-.-, / ! r' V1 o ✓lL�Oi ! 7 C� /�- [� (,G� '�GCn tL �"J QC -t