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Date run 1/26/2016 10:19:42AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 1/26/2016 <br />Record Selection Criteria: Facility ID FA0023285 <br />OWNER FILE INFORMATION (dumber of facilities for this owner: 1 <br />Owner ID OW0021482 <br />Owner Name New Cingular Wireless PCS, LLC dba AT&T <br />Owner DBA <br />Owner Address <br />Home Phone Not Specified <br />Work/Business Phone 214-464-2626 <br />Mailing Address 308 S. Akard St., Room 1708 <br />Dallas, TX 75202 <br />Care of <br />FACILITY FILE INFORMATION <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 />Facility ID / CERS ID <br />FA0023285 10479919 <br />Facility Name <br />AT&T Mobility - HWY 4 - S WAVERLY ROAD <br />Location <br />7603 S Jack Tone Rd <br />Stockton, CA 95215 <br />Phone <br />800-638-2822 x <br />Mailing Address <br />308`8. Akard St., Room 1708 <br />Dallas, TX 75202 <br />Care of <br />AT&T Mobility <br />Location Code <br />Alt Phone <br />BOS District <br />Fax <br />APN <br />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 AR0042866 <br />Mail Invoices to Account Mail Invoices to <br />Account Name AT&T Mobility Manager EH&S EPCRA <br />Account Balance as of 1/26/2016: $0.00 <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 />1926 - HMBP-Unstaffed Network Location PR0540742 EE0000009 - NICHOLAS LOEHRER 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 and/or 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 b <br />EHD Staff: U61 Date k/ / Account out: Date �• <br />COMMENTS: <br />Invoice #: <br />v\Pir <br />'I A-c.li. t-, k TLI Q Y), 0 Gi P-A-V'N <br />Chi <br />