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Date run 5/12/2011 2:10.-41P& SAN Jt'`QUIN COUNTY ENVIRONMENTAL HEA'THDEPARTMENT Report 115021 <br /> Run by :- Pagel. <br /> u Facility Information as of 5112/ <br /> Record selection Criteria: FacilitylD FA0009982 i} <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 New Owner ID 97LOVOQ <br /> 2 <br /> Owner"Name CITY OF STOCKTON- MUD <br /> Owner DBA <br /> Owner Address 2516 NAVY DR 2 ; <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-937-8246 <br /> Mailing Address 2500 NAVY DR <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009982 / <br /> Facility Name CITY OF STOCKTON-MUD f <br /> Location 2501 NAVY DR <br /> STOCKTON, CA. 95206 <br /> Phone 209-937-8712 <br /> Mailing Address 2500 NAVY DRIVE <br /> STOCKTON, CA 95206 <br /> Care of MORRIS L ALLEN <br /> Location Code 01 -STOCKTON Alt Phone 6 <br /> BOS District 001 -VILLAPUDUA Fax 20 4�7 —d' <br /> APN 16332001 EMail : V <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION Ce? ' LCs, ' <br /> Contact Name <br /> Title <br /> Day Phone fX0 � <br /> Night Phone dJ e?144 70V <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016982 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility 1 Account <br /> Account Name CITY OF STOCKTON - MUD WAREHOUSE (Circle One) <br /> Account Balance as of 511212011: $0.00 <br /> (Circle One) <br /> Transfer to Activehnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? , *- Delete <br /> 2220-SM HW GEN<5 TONSNR PR0514119' EE0000418-MICHAEL KITH Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512270 EE0006000-HAZ MAT.SJC OES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PRO514707 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> • r <br /> 23 -UNIFIED PROGRAM FAC STATE SURCHARPR0509982 EE0000000-HAZ MAT SJC OES Inactive Y N it I D <br /> 2831 - ST FAC >1=1,320-<10 K GAL CUMULATAPR0528508 EE0001421 -STACY RIVERA Active,Exempt Y N A 'D <br /> EERSC-ELECTRONIC REPORTING STATE SURCHPRO534031 Inactive Y N I D <br /> LING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agentof same,acknowledge that all site,andlorproject specific,PHSIEHD hourly charges associated with this <br /> ity or activity will be billed to the party identified as the OWNER on this form. I also certify that•ill operations will be performed in accordance with all applicable Ordinate Cortes and/or Standards and <br /> e and/or Federal Laws. JUJO—D <br /> APPLICANT'S NATURE: Ij (� Date( ' I <br /> Program Records to be TRANSFERED: *$25.00,= Amount Paid Date I 1 <br /> Water System to be TRANSFERED: Amount Paid D I 1 . <br /> Payment Type _ �eclmber Receiv <br /> REHS: Date �1?�1 Accwunt out: Date 1 lZ( <br /> COMMENTS: <br /> Ileh-envlenvisionVeports15021.rpt <br />