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Date con 5/7/201410:48:23AM SAN JO NCOUNTY ENVIRONMENTAL HEALOPReport#51321 <br /> Pagel <br /> Run by <br /> Facility Information as of 517/2014 <br /> Record Selection Criteria: Facility ID FA0010185 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 7 SSN/Fed Tax ID : <br /> Owner 1D OW0007162 Case Number: H01642 New Owner ID <br /> Owner Name STOCKTON UNIFIED SCHOOL DIST <br /> Owner DBA STKN UNIFIELD SCHOOL DISTRICT <br /> Owner Address 701 N MADISON ST <br /> STOCKTON, CA 95202 <br /> Home Phone 209-933-7000 <br /> Work/Business Phone 209-933-7050 <br /> Mailing Address 1944 N EL PINAL DR <br /> STOCKTON, CA 95205 <br /> Care of FACILITIES PLANNING DEPARTMENT <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010185 10183301 <br /> Facility Name SUSD STOCKTON UNIFIED SCHL DIST-WH <br /> Location 2909 SANGUINETTI LN <br /> STOCKTON, CA 95205 <br /> Phone 209-933-7150 x0 <br /> Mailing Address 701 N MADISON ST <br /> STOCKTON, CA 952021687 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOIS District 002 - RUHSTALLER, LARRY Fax <br /> APN 11708027 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 AR0017185 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name STOCKTON UNIFIED SCHOOL DIST (CimleOne) <br /> Account Balance as of 5/7/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> Program/Element and Description Record ID Employee ID and Name status New Omer? Delete <br /> 1921 -HMSP-Regular-Primary Location PRO520129 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512473 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510185 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532586 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of some,acknowledge that all site,andror project specific,PH&EHD hourly charges associated with this facility <br /> or activity will be billed to the parry identified as the OWNER on this form l also certify that all operations will be Performed in accordance with all applicable Ordinance Codes arrior Standards and State endfor <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_/_/_ Account out: Date <br /> COMMENTS: <br />