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Date run 12/19/2016 2:15:02F SAN JOAQUIN COUNTY ENVIRONMENTAL IIEEALTM DEPARTMENT <br /> Run by Report#5021 <br /> Facility Information as of 1211912016 Pagel <br /> Record Selection Criteria. Facility ID FA0023792 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) r <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax fD <br /> Owner ID OW0022150 New Owner ID <br /> Owner Name pacific Bell Telephone Company dba AT&T Cz <br /> Owner-DBA <br /> Owner Address <br /> Home phone Not Specified <br /> Work/Business Phone 214-741-0460 <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 FA0023792 10674061 <br /> Facility Name AT&T Corp. - UE17H <br /> Location 2711 E Hammer Ln <br /> Stockton, CA 95210 <br /> Phone 800-335.6088 x <br /> Mailing Address 308 S. Akard St., 17th Floor <br /> Dallas, TX 75202 <br /> Care of AT&T California <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 AR0044061 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name AT&T EH&S (Circle One) <br /> Account Balance as of 1211912016: $$0.00 <br /> (Circle One) <br /> Transfer ItActiveAnactve <br /> ProgramlElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Requiar-Primary Location PRO541502 EE0008709-JAMIE LIMA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. L the undersigned owner,operator or agent of same:,acknowledge that all site,andfor project specific,PHSlEHD 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 wish all applicable Ordinance Codes andlor Standards and State and(or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE Date 1 I <br /> Program Records to be TRANSFFRFD: "$25.00= Amount Paid Date <br /> Water System to be TRANSFFRED: Amount.Paid Date I I <br /> Payment Type ChecoAum er Received byrr <br /> EHD Staff: Date_til l Account out: L4 Date <br /> COMMENTS: <br /> Invoice#: <br /> Rol . <br />