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All <br /> Date run 121612013 3:20:32PA SAN JN COUNTY ENVIRONMENTAL HEA EPARTMENT <br /> Report#5021 <br /> Run by ft Pagel <br /> Facility Information as of 12/6/203 1 <br /> Record Setection Criteria: Facility ID FA0002096 <br /> Make changes/corrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN J Fed Tax 1D <br /> Owner ID OW0014826 New Owner ID <br /> Owner Name SJ CO OFFICE OF EDUCATION <br /> Owner DBA <br /> Owner Address 2707 TRANSWORLD DR <br /> STOCKTON, CA 95206 <br /> Home Phone 209_468-4847 <br /> Work/Business Phone 209-468-9144 <br /> Mailing Address PO BOX 213030 <br /> STOCKTON, CA 95213 <br /> Care of � {DIRECTORV��s��'�,� <br /> FACILITY FILE INFORMATION , <br /> Facility ID J CERS ID FA0002096 10180869 <br /> Facility Name SAN JOAQUIN COUNTY OFFICE OF EDUCE <br /> Location 2911 TRANSWORLD DR <br /> STOCKTON, CA 95206 <br /> Phone 209-468-4847 <br /> Mailing Address PO BOX 213030 <br /> STOCKTON, CA 952139030 <br /> Care of ELSA GONZALES <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 17928013 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION y� J <br /> Contact Narm l "u l Fu C G f <br /> Title DIRECTOR <br /> Day Phone 209-468-4847 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION. <br /> Account ID AR0002104 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner J Facility ! Account <br /> Account Name SAN JOAQUIN COUNTY OFFICE OF EDUCATION (circle one) <br /> Account Balance as of 112/6/20113: $0.00 <br /> (Circle One) <br /> Transfer to Aclivellnactve <br /> Prograr,ofElement and Description Record lD Employee ID and Name Status New Owner? Deiete <br /> 1632-EXEMPT FOOD PRO160692 EE0008999•LEYNA HUYNH Active Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PR0520052 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PR0537284 EE0009817-ROBERT LOPEZ Active,! Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512350 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510062 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,and+or project specific,PHSIEHO hourly charges associated with this facility <br /> or activity will be billed to the party Identiied as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes anclor Slandards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! ! <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date I ! <br /> Water System to be TRANSFEREI3Amount Paid Date ! J <br /> Payment Type f Check Number Rec ed by <br /> REHS: Date4-zzJ 1 Account out: Date <br /> COMMENTS: <br />