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Report#5021 <br /> Date run 1218/2016 10:07:33AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEA LTII DEPARTMENT Pagel <br /> Run by Facility Information as of 12/8/2016 <br /> Record Selection Criteria: Facility ID FA0021357 <br /> Make changesfcorrections in RED ink. <br /> INFORMATION CHANGE(date) C� <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 3 SSN 1 Fed Tax ID <br /> Owner ID OW0015848 New Owner ID <br /> Owner Name Nextel of California <br /> Owner DBA NEXTEL <br /> OwnerAddresS 1120 W MARCH LN <br /> STOCKTON, CA 95219 <br /> Home Phone Not Specified <br /> Work/Business Phone 877-347-4457 <br /> Mailing Address P.O. BOX 7994 <br /> SHAWNEE MISSION, KS 66207 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID 1 CERS ID FA0021357 10187809 <br /> Facility Name NEXTEL COM INC CA-1824/ MCHEINRY <br /> Location 25187 E RIVER RD <br /> IESCALON, CA 95320 <br /> Phone $77-347-4457 <br /> Mailing Address PO BOX 7994 <br /> SHAWNEE MISSION, KS 66207 <br /> Care of <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 004 -WINN, CHARLES Fax <br /> APN 24710004 Entail <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 877-347-4457 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION NewAccountlD: <br /> Account ID AR0038722 <br /> Mail Invoices to: Owner i Facility 1 Account <br /> Mail Invoices to Facility (circle one) <br /> Account Name NEXTEL COM INC CA-18241 MCHENRY <br /> Account Balance as of 12/812016-. $0.00 (Circle One) <br /> Transfer tc Acfivellnactve <br /> ProgramfElement and Description Record ID Employee ID and Name <br /> Status New Owner? Delete <br /> 1926-HMBP-Remote Network Location PRO537224 EE0000009-NICHOLAS LOEHRER <br /> Active Y N A 01 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the DANER on this farm. I also certify that ali operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State andfor <br /> Federal Laws. <br /> Date ! f <br /> APPLICANT'S SIGNATURE: <br /> Amount Paid Date 1 1 <br /> Program Records to be TRANSFERED: `$25.00 Amount Paid Date ! 1 <br /> Water System to be TRANSFERED: Received by <br /> Payment Type Check Number -4 ��1 _1 4 <br /> Z� pate1 -1 Account out: � Date <br /> EHD Staff: Invoice#: <br /> COMMENTS: <br />