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Date run 8/4/2009 11:08:01AM SAN JOIN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Report#5021 <br /> Run by 1273 , Pagel <br /> Facility Information as of 8!4/20 <br /> Record Selection Criteria: Facility ID FA0003953 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0007855 Case Number: H05656 New Owner ID <br /> Owner Name AT&T COMMUNICATIONS <br /> Owner DBA t tVy Ty Owner Address 898 MARIE T 7 <br /> CONYERS, GA 30094 <br /> Home Phone Not Specified <br /> Work/Business Phone 925-823-0725 <br /> Mailing Address 2600 CAMINO RAMON #3E000 A KtrahS rr "PIy/NL J�npO <br /> SAN RAMON, CA 94583 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003953 <br /> Facility Name AT&T COMMUNICATIONS <br /> Location 7717 ELM ST <br /> FRENCH CAMP, CA 95231 <br /> Phone 209-982-0010 x0 n <br /> Mailing Address POX 50 u7 D`$ s /TIc �Q WL J1,90SP 1f RAAN CA 945830995 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 19310027 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003564 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name AT&T COMMUNICATIONS (Circle One) <br /> Account Balance as of 8!4/2009: $0.00 <br /> (Circle One) <br /> Transfer to Active/InacIve <br /> Program(Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511789 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CalARP PROGRAM PR0514602 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0519685 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PRO507737 EE0007289-ALISON YOUNGBLOODInactive Y N A I D <br /> 2361 -UST FACILITY PR0231870 EE0008317-RAYMOND VON FLUE Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0507543 EE0008317-RAYMOND VON FLUE Inactive Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATRPR0527963 EE0005642-MICHELLE HENRY Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator of agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: $372.00= Amount Paid Date / / <br /> Payment Type Check Number Receive y <br /> REHS: Date / / Account out: <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />