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Date run 2/25/2015 10:43:45AI SAN JOII JIN COUNTY ENVIRONMENTAL HEA&DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/25/2015 <br /> Record Selection Criteria: Facility ID FA0003705 <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: 86 SSN/Fed Tax to <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 lDICER$ ID FA0003705 10181327 <br /> Facility Name CITY OF STOCKTON FIRE STATION#4 <br /> Location 5525 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone 209-937-8801 x <br /> Mailing Address 5525 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Care of STOCKTON FIRE STATION#4 <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOB District 002 - MILLER, KATHERINE Fax <br /> APN 10816001 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 AR0003284 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> (Circle One) <br /> Account Name CITY TO�I �II EP TMENT <br /> Account Balance as of 2/25/201 - $135.00 \��{`1�/\J (Circle One) <br /> 1 r/� rensler to AclivellnacNe <br /> PrograMElemenl and Description Rec D Employee ID and Name Statu.4)()✓f Own., Delete <br /> 1920-HMBP-Common Materials P 0539632 EE0000006-HAZA SAEED Active,l 111 Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512075 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0231220 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509787 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO528815 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,anNor project specific,PHSlEHD hourly charges associated with thisfacility, <br /> or activity will be billed to the party identified as the OWNER on this form I also tartly 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 <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 -7 Receiv by <br /> REHS: Date <br /> L'Z- l QQQ���V ��nlAcj/co+�unt�out: 1 Date <br /> COMMENTS: U <br /> 'e\I je-- <br />