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Datemn- 4/9/2014 8:47:31AM SAN JO,.,UIN COUNTY ENVIRONMENTAL HEA)`. DEPARTMENT Reportu5o21 <br /> Run by 1273 Pagel <br /> Facility Information as of 4/9/2014 <br /> Record Selection Criteria: Facility ID FA0020359 <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: 2 SSN/Fed Tax ID <br /> Owner ID OW0015115 New Owner ID <br /> Owner Name WEYERHAEUSER <br /> Owner DBA WEYERHAEUSER <br /> Owner Address 1111 HUMPHREYS AVE <br /> STOCKTON, CA 95203 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-942-1825 <br /> Mailing Address 2700 S CALIFORNIA ST <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS 10 FA0020359 10,187,599 <br /> Facility Name WEYERHAEUSER <br /> Location 1004 HUMPHREYS AVE <br /> STOCKTON, CA 95203 <br /> Phone 209-942-1825 <br /> Mailing Address 2700 S CALIFORNIA ST <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 003 - BESTOLARIDES Fax <br /> APN 16203007 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 AR0036346 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name WEYERHAEUSER (Circle One) <br /> Account Balance as of 4/9/2014: '$t9a3AQ <br /> (Circle One) <br /> Transfer to Acbve/Inative <br /> Program/Element and Description Record ID Employee ID and Name status New Owner? elate <br /> 1920-HMBP-Common Materials PRO535244 EE0009817-ROBERT LOPEZ Active Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0535273 Inactivc Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,me undersigned owner,operator or agent of same,eanowledge that all site,anNor project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on thisform. l also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ani <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 Receiv <br /> REHS: Date / / Account out: Date /_�/ <br /> MMENT Lr <br /> 5, 13 <br />