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Date nn 11/24/2008 2:15:04P SAN JO UIN COUNTY ENVIRONMENTAL HEA/ 'f DEPARTMENT Report p5D21 <br /> Run oils,y' Pagel <br /> Facility Information as of 11/24/20 <br /> Record Selection Cnteria: Facility ID FA0010699 <br /> Make changesicorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008734 New Owner ID <br /> Owner Name VERIZON WIRELESS INC <br /> Owner DBA <br /> Owner Address 2785 MITCHELL DR BLD9 1STFL <br /> WALNUT CREEK, CA 94598 <br /> Home Phone Not Specified <br /> Work/BusinessPhone 925-527-9600 <br /> Mailing Address 2785 MITCHELL DR BLDG 9 1ST FLR <br /> WALNUT CREEK, CA 94598 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010699 <br /> Facility Name VERIZON -EIGHT MILE RD CELL SITE <br /> Location 1060 LOWER SACRAMENTO RD 1 U/o 0 l <br /> STOCKTON, CA 95210 <br /> Phone 209-956-3606 <br /> Mailing Address 2785 MITCHELL DR <br /> WALNUT CREEK, CA 94598 <br /> Care of RICHARD DAY <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN 08404008 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 AR0017699 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name VERIZON -EIGHT MILE RD CELL SITE (C4C1e Ona) <br /> Account Balance as of 11/24/2008: $0.00 <br /> (Circe,One) <br /> Transfer to Aceveflraotve <br /> ProgramfEkanent and Dascn0w Record ID Empbyee 10 and Name statin New Ovnx(7 Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512987 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO510699 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528877 EE0000753-WILLY NG Active,Exempt Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the urclersigred owner,operator or agent of same,acknoeledge that all site,anNor Project specific.PHS/EHD Iwly charges aeaocaled with this <br /> facility or activity will tie billed to the party identified as the OWNER on me;form. I also car*that all operations will to perfomned In accordance with all applicable Ordinate Codes ar Vor Star)Wrds and <br /> Sate anOfor Federal Laws. <br /> APPLICANTS SIGNATURE: Date I / <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 ReceW y <br /> RENS: k N- NIG. Date / Account out: Date_U/ 4z <br /> COMMENTS: <br /> LoU�-n� A^DOft-�S vUaS M�551Na 4- D tG1 <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />