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Date run 9/25/2014 4:54:49PR SAN JO _UIN COUNTY ENVIRONMENTAL HEAT I DEPARTMENT Report#5021 Run by Pagel Facility Information as of 9/25/2014 Record Selection Criteria: Facility ID FA0003877 OWNER FILE INFORMATION Number of facilities for this owner: 86 Owner ID OW0001176 Owner Name Main Street Stockton, LLC C/O CBRE, Inc. Owner DBA PR0231253 Owner Address 425 N EL DORADO ST 2831 -AST FAC >/= 1,320 - <10 K GAL CUMULATIVE STOCKTON, CA 95202 Home Phone Not Specified Work/Business Phone 209-946-9626 Mailing Address 400 E Main St., Ste. 127 Stockton, CA 95202 Care of FACILITY FILE INFORMATION Facility ID / CERS ID FA0003877 10181501 Facility Name STOCKTON FIRE STATION #02 Location 110 W SONORA ST STOCKTON, CA 95203 Phone 209-944-8271 Mailing Address 425 N EL DORADO ST RM 312 STOCKTON, CA 95202 Care of STOCKTON CITY ACCTS PAYABLE Location Code 01-STOCKTON Bos District 001 - VILLAPUDUA APN 13731025 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0003465 Mail Invoices to Facility Account Name STOCKTON FIRE STATION #02 Account Balance as of 9/25/2014: $0.00 Ilement and Description Record ID Xr __HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512074 2381 - UST FACILITY (BEFORE 1/84) - obsolete PR0231253 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509786 2831 -AST FAC >/= 1,320 - <10 K GAL CUMULATIVE PRO528823 ERSC - ELECTRONIC REPORTING STATE SURCHARG PRO531758 Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN/ Fed Tax ID New Owner ID : Site Mitigation Facility Alt Phone Fax EMail : 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 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 andlor Standards and State andor Federal Laws. APPLICANT'S SIGNATURE: _ — Date / q_ / Program Records to be TRANSFERED: Water System to be TRANSFERED: Payment Type Check Number REHS: COMMENTS: * $25.00 = Amount Paid Date Amount Paid Date Date / / R cei a by / Account out: Date / / G New Account ID: Mail Invoices to: Owner / Facility / Account (Circle One) (Circle One) Transfer to Active/Inactve Employee ID and Name Status New Owner? Delete EE0009817 - ROBERT LOPEZ Active,I Y N A I D EE0000418 - MICHAEL KITH Inactive Y N A I D EE0000000 - HAZ MAT SJC OES Inactive Y N A I D EE0001421 - STACY RIVERA Active,l Y N A I D InactivE Y N A I D 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 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 andlor Standards and State andor Federal Laws. APPLICANT'S SIGNATURE: _ — Date / q_ / Program Records to be TRANSFERED: Water System to be TRANSFERED: Payment Type Check Number REHS: COMMENTS: * $25.00 = Amount Paid Date Amount Paid Date Date / / R cei a by / Account out: Date / / G