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Date tin 8/27/2014 9.23:33AA SAN JON <br /> 'IIN COUNTY ENVIRONMENTAL HEAT 'DEPARTMENT Report#5021 <br /> Run by 7 'e-W Pagel <br /> Facility Information as of 8/27/2014 <br /> Record Selection Catena: Facility ID FA0010208 <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: 4 SSN/Fed Tax ID <br /> Owner ID OW0008208 New Owner ID <br /> Owner Name FEDERAL AVIATION ADMIN <br /> Owner DBA FEDERAL AVIATION ADMIN (PRIMAR <br /> Owner Address 11025 TRADE CENTER DR <br /> RANCHO CORDOVA. CA 95670 <br /> Home Phone Not Specified <br /> Work/Business Phone 208-946-6310 <br /> Mailing Address 11025 TRADE CENTER DR <br /> RANCHO CORDOVA, CA 95670 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010208 10183317 <br /> Facility Name FEDERAL AVIATION ADMIN <br /> Location 7434 S LINDBERGH ST <br /> STOCKTON, CA 95206 <br /> Phone 29Q-2a4--f69G-*— <br /> Mailing Address 7434 S Lindbergh Street <br /> Stockton, CA 95206 <br /> Care of Federal Aviation Administration (SCK ATCT) <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 17726034 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 61 X-7 (i <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID ARD017208 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name FEDERAL AVIATION ADMIN (CaaeOne) <br /> Account Balance as of 8/27/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> PrograndElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMSP-Regular-Primary Location PR0520214 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0539089 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512496 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-Cali PROGRAM PR0514738 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510208 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533827 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander project specific,PHS/EHD hourly charges associated with this reality <br /> or activity will be billed to the party identRed as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes anNar Starreards and State andfor <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 ype Check Number ReoeivVr <br /> REHS 44\\���� Date I / Account out: Date_ <br /> COMMENTS: <br />