Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
Date run 5/11/2017 5:05:04PK SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/11/2017 <br /> Record SeleVon Crites•. Facility ID FA0021466 <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: 17 SSN/Fed Tax ID <br /> Owner ID OW0016711 New Owner ID <br /> Owner Name T-MOBILE WEST, LLC <br /> Owner DBA METRO PCS SAC <br /> Owner Address 12920 SE 38th ST <br /> BELLEVUE, WA 98006 <br /> Home Phone 888-313-0188 <br /> Work/Business Phone 425-383-4000 <br /> Mailing Address 12920 SE 38th Street <br /> Bellevue, WA 98006 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021466 10187947 <br /> Facility Name METRO PCS - SAC215 ALHAMBRA& MORA <br /> Location 9775 N HWY 99 <br /> STOCKTON, CA 95212 <br /> Phone 888-313-0188 x <br /> Mailing Address 785 ORCHARD DR, STE 200 10 <br /> FOLSOM, CA 95630 <br /> Care of METROPCS CA, LLC <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 002 - MILLER, KATHERINE Fax <br /> APN 12429005 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name JENNIFER BANGLOS <br /> Title <br /> Day Phone 916-984-2652 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0038853 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name T-MOBILE WEST, LLC (Circle One) <br /> Account Balance as of 5/11/2017: b74.4-0— L-.,e r Vc'- 2"J ; <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO537361 EE0008709-JAMIE LIMA Active Y N A V D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD 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 and/or Standards and State andlor <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 Date <br /> Payment Type Check Number Received by <br /> EHD Staff: Date !� / _ Account out: LL—Date-5 !—T51 /-7 <br /> COMMENTS: <br /> Invoice#: <br />