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Date run 2/25/2015 10:45:10AI SAN JOAN COUNTY ENVIRONMENTAL HEAL'>✓dEPARTMENT Report 715021 <br /> Run by <br /> Facility Information as of 2/25/2015 Pagel <br /> Record Selection Criteria: Facility ID FA0009791 <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: 3 SSN/Fed Tax ID : <br /> Owner ID OW0007789 Case Number: H05424 New Owner ID <br /> Owner Name CITY OF STOCKTON FIRE DEPARTMENT <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 209-397-8801 <br /> Mailing Address 425 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility lD/CERS ID FA0009791 10182911 <br /> Facility Name CITY OF STOCKTON FIRE STATION#9 <br /> Location 550 E HARDING WAY <br /> STOCKTON, CA 95204 <br /> Phone 209-937-8029 x <br /> Mailing Address 550 E HARDING WAY <br /> STOCKTON, CA 95204 <br /> care of STOCKTON FIRE STATION#9 <br /> Location Code Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 13921007 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 AR00167911 ^ New Account ID: <br /> Mail Invoices to Account tV1\` Mail Invoices to: Owner / Facility / Account <br /> Account Name CITY O T (Circle One) <br /> Account Balance as of 2/25/2 5: $305.00 <br /> (Circle One) <br /> Transfer to Aclivellnactve <br /> Progra"Element and Description Record ID Employee 10 and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO539643 EE0000006-HAZA SAEED Active,l Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512079 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PRO501518 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509791 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528821 EE0000005-FATINAH ZAREEF Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,admowledge that all site,andror project specific,PHSEHD 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 anNor Standards and State andbr <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 o Received by 1` <br /> REHS: Date��/_�/ Account out: Date <br /> COMMENTS: { <br /> ��I 1,,/. yJ <br />