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Date run 12/1912016 2:52:22F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/19/2016 <br /> Record Selection Criteria: Facility ID FA0023794 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 SSN I Fed Tax ID <br /> Owner ID OW0022152 New Owner ID <br /> owner Name Pacific Bell Telephone Company dba AT&T CE <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 214-741-0460 <br /> Mailing Address 308 S. Akard St., 17tH Floor <br /> Dallas, TX 75202 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0023794 10676581 <br /> Facility Name AT&T California - UE1 LW <br /> Location 340 N Lower Sacramento Rd <br /> Lodi, CA 95242 <br /> Phone 800-335-6088 x <br /> Mailing Address 308 S. Akard St., 17th Floor <br /> Dallas, TX 75202 <br /> Care of AT&T California <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN Entail. <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0044063 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility ! Account <br /> Account Name AT&T EH&S (Circle One) <br /> Account Balance as of 12/19/2016: $0.00 <br /> (Circle One) <br /> Transfer to Active/inactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0541504 EE0008709-JAMIE LIMA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I.the undersigned owner,operator or agent of same,acknowledge that all site.and/or project specific,PHSfEHD 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 andfor Standards and State and/or <br /> Federal Laws <br /> APPLICANT'S SIGNATURE: Date / 1 <br /> Program Records to be TRANSFERED '$25.00= Amount Paid Date / ! <br /> Water System to be TRANSFERED Amount Paid Date I I <br /> Payment Type Check Number Receive�d,b <br /> EHD Staff: ;a Date Account out: ✓r+:/ Date X13 I - <br /> COMMENTS: <br /> Invoice#' <br /> g+f I WWI <br />