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Date run 12/15/2015 10:00:34/ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 12/15/2015 <br /> Record Selection Criteria: Facility ID FA0010925 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0008925 Case Number: H08982 New Owner ID <br /> Owner Name OUTFRONT MEDIA <br /> Owner DBA CBS OUTDOOR SACRAMENTO OFFICE <br /> Owner Address 2050 W FREMONT ST <br /> STOCKTON, CA 95203 <br /> Home Phone Not Specified <br /> Work/Business Phone 973-575-6900 <br /> Mailing Address PO BOX 404 <br /> BROADWAY, NJ 08808-0404 <br /> Care of FORREST PORTER <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010925 10183939 <br /> Facility Name OUTFRONT MEDIA STOCKTON OFFICE <br /> Location 2050 W FREMONT ST <br /> STOCKTON, CA 95203 <br /> Phone 209-466-5022 x <br /> Mailing Address PO BOX 404 <br /> BROADWAY, NJ 08808-0404 <br /> Care of FORREST PORTER <br /> Location Code 01 -STOCKTON Alt Phone <br /> Bos District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 13336046 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name Forrest Porter <br /> Title Operations Manager <br /> Day Phone 209-466-5021 <br /> Night Phone 209-649-3174 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017925 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility I Account <br /> Account Name OUTFRONT MEDIA (Circle OM) <br /> Account Balance as of 12/15/2015: $0.00 <br /> (Circle One) <br /> Transfer to ActivellnacNe <br /> PrograMElement and Description Reci ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520553 EE0009817-ROBERT LOPEZ Active Y N A D <br /> 2220-SM HW GEN<5 TONS/YR PR0514454 EE0001421 -STACY RIVERA Active Y N I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO513213 EE0000000-HAZ MAT SJC DES InaCtIVE Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510925 EE0000000-HAZ MAT SJC DES Inactiv( Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533531 InactIVE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge Nat all site,ardor project specific,PHSIEHD hourly charges associated with Nis facility <br /> or to*vity will be billed to Ne parry identified as the OWNER on Nis form I also caddy that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State andor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date / I <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date <br /> Water System to be TRANSFERS : Amount Paid Date <br /> Payment Type heck Number Received by <br /> EHD Sta Date, /&-;,3 / Account out: Cti Date 1l'I '1 if l S ' <br /> COMMENTS: <br /> c _ / Invoice#: <br />