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Dae ren 3/5/2014 2:01:27PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Rvn by Paget <br />Facility Information as of 3/5(2014 <br />RemN Se'acin(lttarla- Facility ID- FA0003761 <br />OWNER FILE INFORMATION <br />Ovmer ID OW0000781 <br />Owner Name ST JOSEPHS MEDICAL CENTER <br />Owner DBA <br />Owner Address 1800 N CALIFORNIA <br />STOCKTON, CA 95204 <br />Home Phone 209-956-3400 <br />Work/Business Phone 209-943-2000 <br />Mailing Address PO BOX 213008 <br />STOCKTON, CA 95213-9008 <br />Care of FACILITIES DEPARTMENT <br />FACILITY FILE INFORMATION <br />Facility lD/CERS ID FA0003761 10,181,391 <br />Facility Name ST JOSEPHS HOSPITAL <br />Location 1800 N CALIFORNIA ST <br />STOCKTON, CA 95204 <br />Phone 209-943-2000 x <br />Mailing Address 3400 DATA DR <br />RANCHO CORDOVA. CA 95670 <br />Care of CHW ACCTS PAYABLE (3RD FLR) <br />Location Code 01-STOCKTON <br />BOS District 002 - RUHSTALLER, LARRY <br />APN 12718044 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0003340 <br />Mail Invoices to Facility <br />Account Name ST JOSEPHS HOSPITAL <br />Account Balance as of 3/5/2014: $3,457.00 <br />Pmgra.M.mentend DeacdpGen <br />Record ID <br />.1626-RESTAURANT/BAR 101+ SEATS <br />PRO160504 <br />1921 - HMBP-Regular-Primary Location <br />PRO519820 <br />2217 - APPLIANCE RECYCLER <br />PRO536119 <br />2224-HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PRO512004 <br />2226 - CeIARP PROGRAM <br />PR0514656 <br />2.227 - GEN 5<25 TONS PERMIT <br />PRO538410 <br />2247 - RCRA GEN 5<25 TONS <br />PRO514003 <br />2301- UST STATE SURCHARGE FEE <br />PR0515549 <br />2301 - UST FACILITY <br />PR0231038 <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F <br />PR0507445 <br />2832 -AST FAC 10 K- 4=100 K GAL CUMULATIVE <br />PR0528692 <br />2951 - UGT-CAP <br />PROO10361 <br />4522 - ACUTE CARE FACILITY <br />PRO450006 <br />4557 - MED WASTE LIMITED HAULER <br />PRO522306 <br />ERSC- ELECTRONIC REPORTING STATE SURCHARG <br />PRO532652 <br />4630 - NTNC WATER SYSTEM <br />WA0461082 <br />Make Bhang *corn l ons in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) 3-6-2014 <br />SSN/Fed T"ID 4-1 <br />New Owner ID : <br />Dignity Health Formerly Catholic Health Care West <br />St. ]oseoh's Medical Center <br />St. Joseph's Medical Center <br />Dignity Health ACCTS PAYABLE (3rd FLR) <br />Alt Phone <br />Fax <br />EMsil : <br />New Account 1 D: <br />: <br />Mail Invoices to: <br />Owner / <br />Facility <br />/ <br />Amount <br />(Gini. one) <br />(Gide One) <br />TranahrN <br />Acbvdlnactve <br />Employee b and Nome <br />staNa <br />New ownea <br />Delete <br />EE0001084- STEPHANIE RAM IREZ' <br />Active <br />Y <br />N <br />A <br />1 D <br />EED009817-ROBERT LOPEZ <br />Active <br />Y <br />N <br />A <br />I D <br />EE0004636 - GARRETT 13ACKUS <br />Active,l <br />Y <br />N <br />A <br />I D <br />EE0000000 - HAZ MAT SJC GES <br />Inactive <br />Y <br />N <br />A <br />I D <br />EE0000000 - HAZ MAT SJC DES <br />Inactive <br />Y <br />N <br />A <br />I D <br />EE0004630 - GARRETT BACKUS <br />Inactive <br />Y <br />N <br />A <br />I D <br />EEOD04636 - GARRETT 13ACKUS <br />Active <br />Y <br />N <br />A <br />I D <br />EEW00008 - LETITIA BRIGGS <br />Inactive <br />Y <br />N <br />A <br />I D <br />EE0004630 - GARRETT BACKUS� <br />Active <br />Y <br />N <br />A <br />I D <br />EE0000008 - LETITIA BRIGGS <br />Inactive <br />Y <br />N <br />A <br />1 D <br />EE0004630 - GARRETT BACKUS / <br />Active <br />Y <br />N <br />A <br />I D <br />EE0000684 - MICHAEL INFURNA <br />Inactive <br />Y <br />N <br />A <br />I D <br />EE0002620- ALFONSO ARAMBULA' <br />Active <br />Y <br />N <br />A <br />1 D <br />EED003973 - ROBERT MCCLELLON <br />Active <br />Y <br />N <br />A <br />1 D <br />Inactive <br />Y <br />N <br />A <br />I D <br />EE0005838 - ADRIENNE ELLSAESSER� <br />Active <br />Y <br />N <br />A <br />I D <br />