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Date run 8/14/2014 3:31:OOPAReporl#5021 <br /> SAN J�.2UIN COUNTY ENVIRONMENTAL HE��H DEPARTMENT <br /> Run by Pagel <br /> Facility Information as of 8/14/2014 <br /> Record Selection Criteria: Facility ID FA0000086 <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 OW0000074 New Owner ID <br /> Owner Name SAN JOAQUIN CO HEALTH CARE <br /> Owner DBA <br /> Owner Address 500 W HOSPITAL RD <br /> FRENCH CAMP, CA 95231 <br /> Home Phone 209-468-6790 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 1499 <br /> FRENCH CAMP, CA 95231 <br /> Care of ACCTS PAYABLE <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0000086 10180527 Site Mitigation Facility <br /> Facility Name SJ GENERAL HOSPITAL <br /> Location 500 W HOSPITAL RD <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-468-6000 <br /> Mailing Address PO BOX 1499 <br /> FRENCH CAMP, CA 95231 <br /> Care of MARTINEZ, PAUL- HSKP <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 19305010 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name HOSPITALICANTEEN <br /> Title <br /> Day Phone 209468-6790 <br /> Night Phone 209468-6790 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000085 New Account ID. <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name SJ GENERAL HOSPITAL (Circle One) <br /> Account Balance as of 8/14/2014: $0.00 <br /> (Circle One) <br /> Transfer to Actmegnactwe <br /> Program/Element and Description Record ID Employee 10 and Name Status New OamaY Delete <br /> 1632-EXEMPT FOOD PRO161157 EE0001420-MELISSA NISSIM Active Y N A I D <br /> 1632-EXEMPT FOOD PRO163362 EE0001420-MELISSA NISSIM InactivE Y N A I D <br /> 2213-HAZ WASTE CE FAC STATE SURCHARGE FEE PRO506967 EE0000451 -STEVE SASSON InactivE Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO516262 EE0002646-THUY TRAN Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511359 EE0000000-HAZ MAT SJC OES Inactiv( Y N A I D <br /> 2233-HAZARDOUS WASTE CESQT FACILITY PRO506966 EE0000451 -STEVE SASSON InactivE Y N A I D <br /> 2233-HAZARDOUS WASTE CESQT FACILITY PR0507103 EE0000451 -STEVE SASSON Inactiv( Y N A I D <br /> 2301-UST STATE SURCHARGE FEE PR0508273 EE0000451 -STEVE SASSON Inactiv( Y N A I D <br /> 2361 -UST FACILITY PR0231614 EE0002646-THUY TRAN Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0506968 EE0000451 -STEVE SASSON InactivE Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PRO516150 EE0002646-THUY TRAN Aclive,I Y N A I D <br /> 3616-PUBLIC POOUSPA-EXEMPT PR0360445 EE0001084-STEPHANIE RAMIREZ InactivE Y N A I D <br /> 4522-ACUTE CARE FACILITY PRO450005 EE0003973-ROBERT MCCLELLON Active Y N A I D <br /> 4557-MED WASTE LIMITED HAULER PR0515137 EE0003973-ROBERT MCCLELLON Active Y N A 1 0 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531570 InactivE Y N A I D <br />