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Dale mn 41 8:47:06AM SAN JO�JIN COUNTY ENVIRONMENTAL HEAI�t DEPARTMENT Report#5021 <br /> Run DY 1271 <br /> Facility` Information as of 4/9/2014 Pagel <br /> Rewrd Selection Criteria: Facility ID FA0018396 <br /> Make changesicorrections 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 ID FA0018396 10,186,863 <br /> Facility Name WEYERHAEUSER <br /> Location 1111 HUMPHREYS AVE <br /> STOCKTON, CA 95203 <br /> Phone 209-942-1825 <br /> Mailing Address 2700 S CALIFORNIA ST <br /> STOCKTON, CA 85206 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA 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 AR0032443 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name WEYERHAE ER (Circle One) <br /> Account Balance as of 4/9/2014: ^11 20 I L4, 'Fte s <br /> (Circle one) <br /> Transfer to AdivellnacNe <br /> Prolmi mlElement and Description Record ID Employee ID and Name Status New Owner? late <br /> 1920-HMBP-Common Materials PR0527137 EE0009817-ROBERT LOPEZ Active Y N AI D <br /> 2220-SM HW GEN<5 TONS/YR PRO537815 EE0001421 -STACY RIVERA Active Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533664 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENTI,the undersigned owner,operator or agent ofsame,acknowledge that all site,anNor project specifc,PH&EHO 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 motor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid ate <br /> Payment Type - Check Number Re y <br /> RENS: Date / / Account out: Date /1�/ ' <br /> �,ENTS <br /> 9 / �� <br /> r,,z, 4-'e.- . C�� Q .Da, l3 7 13 . <br />