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Date run 4/6/2016 3:43:44PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 4/6/2016 <br />Record Selection Criteria: Facility ID FA0022559 <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 : 1 SSN / Fed Tax ID <br />Owner ID OW0020123 New Owner ID <br />Owner Name New Cingular Wireless PCS, LLC dba AT&T M <br />Owner DBA <br />OwnerAddress <br />308 S AKARD ST 1708 <br />DALLAS, TX 75202 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />214-464-2626 <br />Mailing Address <br />308 S. Akard St., Room 1708 <br />Dallas, CA 75202 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0022559 10484245 <br />Facility Name <br />AT&T Mobility - HWY 4 -KAISER ROAD (USID, <br />Location <br />7575 E HWY 4 <br />STOCKTON, CA 95215 <br />Phone <br />800-638-2822 x <br />Mailing Address <br />308 S Akard St., Room 1708 <br />Dallas, TX 75202 <br />Care of <br />AT&T Mobility <br />Location Code <br />Alt Phone <br />BOS District <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Fax <br />EMail : <br />Account ID AR0041251 New Account ID: <br />Mail Invoices to Account Mail Invoices to: Owner / <br />Account Name AT&T Mobility Manager EH&S EPCRA <br />Account Balance as of 4/6/2016: $0.00 <br />Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name Status New Owner? 6elete <br />1926 - HMBP-Unstaffed Network Location PR0539454 EE0000009 - NICHOLAS LOEHRER Active Y N A 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: <br />Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Typ Check Number Received b <br />EHD Staff:�/�i(�i� Q� Date / / Account out: Date <br />COMMENTS: <br />Ir1VOICe #: <br />