Laserfiche WebLink
Date mn 10/9/2014 4:24:10PR SAN JOIN COUNTY ENVIRONMENTAL HEAI 'DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/9/2014 <br /> Record Selection Catena: Facility ID FA0001817 <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 OW0018159 New Owner ID <br /> Owner Name 7-ELEVEN INC <br /> Owner DBA <br /> Owner Address 5453 CONSUMNES DR <br /> STOCKTON, CA 95219 <br /> Home Phone Not Specified <br /> Work/Business Phone 800-828-0711 <br /> Mailing Address PO BOX 711, ATTN: ENVIRONMENTAL DEP <br /> DALLAS, TX 75221 <br /> Care of TONI WOOD <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility lD/CERS ID FA0001817 10166191 <br /> Facility Name 7-ELEVEN INC#35355 <br /> Location 3202 W Hammer Ln <br /> Stockton, CA 95209 <br /> Phone 209-957-2900 x <br /> Mailing Address PO BOX 711, ATTN: ENVIRONMENTAL DEP <br /> DALLAS, TX 75221 <br /> Care of 7-ELEVEN INC <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002- RUHSTALLER, LARRY Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name SANAYE WALKER <br /> Title FIELD CONSULTANT <br /> Day Phone 209-957-2900 <br /> Night Phone 925-998-0594 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0001821 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name 7-ELEVEN INC#35355 (Circle One) <br /> Account Balance as of 10/9/2014: $0.00 <br /> (Circle One) <br /> Transferlo Active/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Ovwl Delete <br /> 1617-RETAIL MARKET>1000 SO FT W/FOOD PREP PRO160263 EE0006213-VIDAL PEDRAZA Active Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PR0519486 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO518105 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO511529 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PR0508186 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> 2361-UST FACILITY PR0231129 EE0000005-FATINAH ZAREEF Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO507284 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532525 Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project sIpa igq PHSIEHD hourly charges associated with thisfacility <br /> or activity will be billed to the party identded as the OWNER on this forth. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ands <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date_/_/ <br /> Payment Type Check Number Received by <br /> REHS: Date_/ / Account out: Date <br /> COMMENTS: <br />