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Date run 2/25/2015 10:41:01AI SAN JOIN COUNTY ENVIRONMENTAL I-IEA*DEPARTMENT Report 115021 <br /> Run by Pagel <br /> Facility Information as of 2/25/2015 <br /> Record Selection Criteria: Facility to FA0003701 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 86 SSN/Fed Tax ID <br /> Owner ID OW0001176 New Owner ID <br /> Owner Name CITY OF STOCKTON <br /> Owner DBA <br /> Owner Address 425 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Home Phone 209-937-8212 <br /> Work/Business Phone 209-937-8341 <br /> Mailing Address 425 N EL DORADO ST <br /> STOCKTON, CA 95202 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0003701 10181323 <br /> Facility Name CITY OF STOCKTON FIRE STATION#10 <br /> Location 2903 W MARCH LN <br /> STOCKTON, CA 95219 <br /> Phone 209-937-8801 x <br /> Mailing Address 2903 W MARCH LN <br /> STOCKTON, CA 95219 <br /> Care of STOCKTON FIRE STATION#10 <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002 -MILLER, KATHERINE Fax <br /> APN 11621039 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> t <br /> Account ID AR0003279 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CITY IRE DEPARTMENT (Circle One) <br /> Account Balance as of 2/25/20 <br /> (Circle One) <br /> Transfer to AclivellnacNe <br /> PrograrNElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PR0539631 EE0000006-HAZA SAEED Active) Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512080 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0232401 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509792 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO528814 EE0000005-FATINAH ZAREEF Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anclor project specific,PHSIEHD 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 andror Standards 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 Type Check Number Received by <br /> REHS: Date —2IZ / Account out: Date 2—l�l� <br /> COMMENTS: /� <br />