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Date run 1/10/2017 11:19:21AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 1/10/2017 <br />Record Selection Criteria: Facility ID FA0023819 <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 <br />Owner ID OW0022198 <br />Owner Name AT&T Corp. <br />Owner DBA <br />Owner Address <br />Home Phone Not Specified <br />Work/BusinessPhone 214-741-0460 <br />Mailing Address 308 S. Akard St., 17th Floor <br />Dallas, TX 75202 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0023819 10676692 <br />Facility Name <br />AT&T Corp. - UE1 MN <br />Location <br />1524 S Fresno Ave <br />Stockton, CA 95206 <br />Phone <br />800-335-6088 x <br />Mailing Address <br />308 S. Akard St., 17th Floor <br />Dallas, TX 75202 <br />Care of <br />AT&T Corp. <br />Location Code <br />BOS District <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0044124 <br />Mail Invoices to Account <br />Account Name AT&T EH&S <br />Account Balance as of 1/10/2017: $0.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN /Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Mail Invoices to: <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <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-Reqular-Primary Location PR0541549 EE0009817 - ROBERT LOPEZ Active Y N A I 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 andror Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />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: V/ " Date IT/ I i; / f Account out: L6 Date <br />COMMENTS: <br />Invoice # <br />v\ A <br />Lam. <br />