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Date r n3/25/2014 2 58 26Pn SAN JO JIN COUNTY ENVIRONMENTAL HEA' /DEPARTMENT Report 4115{121 <br /> ` <br /> Run by W V Pagel <br /> Facility Information as of 3/25/2014 <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 Q-7 OO <br /> STOGKTOPI, CA -959 3 �Fock�or l Cp. RS20/o <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0020359 10,187,599 <br /> Facility Name WEYERHAEUSER <br /> Location 1004 HUMPHREYS AVE <br /> STOCKTON, CA 95203 <br /> Phone 209-942-1825 x0 <br /> Mailing Address ;,7pp t�Cvni.4— SAr¢ - <br /> 3 Sock I A g52LXo <br /> Care of <br /> Location Code Alt Phone <br /> BOB 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 (CirdeOne) <br /> Account Balance as of 3/25/2014: $135.00 <br /> (Circle One) <br /> Transfert0 Active/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name Stales New Owner? Delete <br /> 1920-HMBP-Common Materials PRO535244 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0535273 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the underaigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be bitted to the party identified 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 andor <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 Recei d by <br /> REHS: Date / / Account out: Date_�/ 2-(�/ <br /> COMMENTS: <br />