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Date nm 10/2/2008 1:32:34PR SAN JC NUIN COUNTY ENVIRONMENTAL HEA 'H DEPARTMENT Report#5021 <br /> Run by `/ Pagel <br /> Facility Information as of 10/2/20 <br /> Record Selection Criteria- Facility ID FAD011228 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002846 New Owner ID <br /> Owner Name MCI <br /> Owner DBA <br /> Owner Address 2400 N GLENVILLE DR <br /> RICHARDSON, TX 75082 <br /> Home Phone Not Specified <br /> Work/Business Phone 972-729-5671 <br /> Mailing Address 2400 N GLENVILLE DR <br /> RICHARDSON, TX 75082 <br /> Care of MCI <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0011228 <br /> Facility Name MCI WORLDCOM <br /> Location 510 E MAGNOLIA ST <br /> STOCKTON, CA 95202 <br /> Phone 925-822-1344 x0 <br /> Mailing Address 2400 N GLENVILLE <br /> RICHARDSON, TX 75082 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name HOLLY AVEN <br /> Title <br /> Day Phone 916-431-1920 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0018228 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name MCI (Circle One) <br /> Account Balance as of 10/2/2008: $0.00 <br /> (circle One) <br /> Transfer to Adiva/Inaclxe <br /> Pntgram/Elemem and Desciphon Record 10 Employee 10 and Name Status New Owner Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO513516 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520763 EE0000o00-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO511228 EE000o000-HAZ MAT SJC OES Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENTI,the undersigned owner,operator or agent of same,acknowtedge that all site,and/or project specific,PHS/EHD hourly charges assactated with this <br /> facility or activity will be billed to the party identfied as the OWNER on this form. I also candy that all operations will be performed in accordance with all applicable Ortleace Codes andlor Standards and <br /> Slate and/or Fed"laws. <br /> APPLICANTS 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 Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisionslreports\5021.rpt <br />