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Date run 2/27/2014 8:24:26AN SAN JO AN COUNTY ENVIRONMENTAL HEA! DEPARTMENT <br /> Report#5021 <br /> Run by *11111pow %mw Pagel <br /> Facility Information as of 2/2712014 <br /> Record Selection Criteria: Facility ID FA0021385 <br /> Make changes/corrections in RED ink. -7�1lii�--I- - <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0009900 New Owner ID <br /> Owner Name AMERICAN TOWERS <br /> Owner DBA AMERICAN TOWER <br /> Owner Address PO BOX 63604 <br /> PHOENIX, AZ 850823604 <br /> Home Phone 602-284-0280 <br /> Work/Business Phone 602-284-0280 <br /> Mailing Address P.O. BOX 63604 <br /> PHOENIX, AZ 85082 <br /> Care of SCOTT SANDEFUR <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021385 10,187,849 <br /> Facility Name AMERICAN TOWER - EIGHT MILE RD#825 <br /> Location 10601 LOWER SACRAMENTO RD <br /> STOCKTON, CA 95210 <br /> Phone 916-364-8190 <br /> Mailing Address 9828 BUSINESS PARK DR STE A <br /> SACRAMENTO, CA 95827 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 08404008 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 AR0038750 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility 1 Account <br /> Account Name AMERICAN TOWER - EIGHT MILE RD#825 (Circle One) <br /> Account Balance as of 212712014: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> P mfElement and Description Record iD Employee ID and Name Status New Owner? Delete <br /> CI92)6HMBP-Unstaffed Network Location PR0537258 EE0006044-LOWELL ALLEN Active Y N A 0 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operater or agent of same,acknowledge that all site,and/or project specific,PHSIEHD hourly charges associated with this faality <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 and'or Standards and State andlor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date ! J <br /> Water System to be TRANSFERED: Amount Paid Date ! I <br /> Payment TT e Check Number Rece'v <br /> REH <br /> S: T d Nt VVEJ Date �1 11 Account out: Date 1 1 <br /> CQMMENTS: <br />