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03/31/2003 11:40 <br />oats nm 3/28/2003 2:30.58PA <br />Run by <br />Record Selection Criteria: Fac!lhy ID <br />OWNER FILE INFORMATION <br />46401', <br />ENVIRONMENTAL Hr"LTH <br />SAN J�QUIN COUNTI ENW)R,ONWNTAL HEAD DEPARTMENT <br />FA0006687 <br />Facility Information as of 3/28/2003 <br />Owner ID <br />OW0000596 <br />Owner Name <br />WALMART, INC <br />Owner DBA <br />WAL-MART STORES INC #2025 <br />Owner Address <br />1031 10TH $E $T <br />Inactive <br />BENTONVILLE, AR 727160555 <br />Home Phone <br />Not Specified <br />Work/pusiness Phone <br />479-277-2650 <br />Mailing AririrPsc <br />3010 W GIRANT LINE RD <br />x <br />TRACY, CA 95304 <br />Care of <br />1 0 <br />FACILITY FILE INFORMATION <br />Facility ID FA0006687 <br />Facility Name WALMART #1554 <br />Location 3702 E HAMMER LN <br />STOCKTON, CA 95212 <br />Phone 209-473-3438 <br />Mailing Address 3702 E HAMMER LN <br />STOCKTON, CA 952122811 <br />Care of <br />Location Code 01 —STOCKTON <br />BOS District 002 - MARENCO, DARIO <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0009046 <br />Mail Invoices to Owner X <br />Account Name WALMART, INC <br />Account Balance as of 3/28/2003- $547,50 <br />ProuramfEMment and Description <br />Record ID <br />1615 - RETAIL MKT <2000 SQ FT (PREPKGD / LT PRO505294 <br />2213 - HAZ WASTE CE FAC STATE SERVICE FEE PR0506906 <br />2220 - SM HW GEN <5 TONSIYR PRO516652 <br />2221 - USED OIL ONLY - <5 TONS/YR PRO514009 <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO512015 <br />2233 - HAZARDOUS WASTE CESQT FACILITY PR0506905 <br />2244 - PACT TRANSFER RECORD - OES PRO519828 <br />2361 - NEW MULTI UST FACILITY PR0504432 <br />2399 - UNIFIED PROGRAM FAC STATE SERVICE FPRO506907 <br />2399 - UNIFIED PROGRAM FAC STATE SERVICE FPRO509727 <br />Employee ID and Name <br />PAGE 07 <br />Report #6021 <br />Make changes/corrections In RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) _.._ <br />New Owner ID : <br />702 S(..) as"" SJ <br />a✓r :?,;22-7 <br />- <br />5>01-/ —01q0 <br />Sw gl 4- -51 <br />S <br />r <br />1 1P -7 O <br />A, <br />APN: <br />SIC Code -9900 <br />New Account ID: <br />Mail Invoices to,. Facility / Account <br />(Cirdo ono) <br />EE0003027 - MINH NGUYEN <br />EE0000418 - MICHAEL KITH <br />EE0003580 - MICHELLE LE <br />EE0000008 - LETITIA BRIGGS <br />EE0000000 - HAZ MAT SJC OES <br />EE0900418 - MICHAEL KITH <br />EE0000451 - STEVE SASSON <br />EE0000418 - MICHAEL KITH <br />EE0000000 - HAZ MAT SJC OES <br />SlatU3 <br />Transfer to <br />New Owner? <br />(Circle Orre) <br />ActWnacbre <br />Delete <br />Active <br />Y N <br />A <br />I 0 <br />Inactive <br />Y N <br />A <br />I D <br />Active <br />Y N <br />A <br />I D <br />Inactive <br />Y N <br />A <br />1 0 <br />Active <br />Y N <br />A <br />I D <br />Inactive <br />Y N <br />A <br />I D <br />Active <br />Y N <br />A <br />I D <br />Inactive <br />Y N <br />A <br />I D <br />Inactive <br />Y N <br />A <br />I D <br />Inactive <br />Y N <br />A <br />I D <br />BILLING 2nd COMPLIANCE ACKNOWLEDGEMENT: 1, the undorslgmd owner, operator or agent of same, acknowledge that art slte, andtar project speclnc, PHS/EHO hourly charges associated with this <br />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 Ordnace Codes and/or Standards and <br />.tate and/or FedersI Laws. <br />APPLICANT'S SIGNATURE: - _ _ Date <br />Program Records to be TRANSFERED: ' f — Amount Paid Pate J I <br />Water System to be TRANSFERED: ' $155,00 ' Amount Paid Date / <br />Payment Type _ Check Number Received by <br />REHS: Date / / Account out: Date O q <br />COMMENTS: <br />\\Phs-ehsgl-ntlap ps\E nvisionslRepotts\5021. rpt <br />