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Date mn 3/9/2011 3:33:33PM SAN JOA/)UIN COUNTY ENVIRONMENTAL HEAL^-H DEPARTMENT Report#5021 <br /> Run by 4006 <br /> -W, Facility Information as of 3/9/20re Paget <br /> Record Selection Criteria: Facility ID FAO-012697 <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 OW0003627 New Owner ID <br /> Owner Name CALIFORNIA WATER SERVICE <br /> Owner DBA CALIFORNIA WATER SVC- PRIMARY <br /> Owner Address 1720 N FIRST ST <br /> SAN JOSE, CA 95112 <br /> Home Phone 800-750-8200 <br /> Work/Business Phone 26.9 488 B9.7.4_� <br /> Mailing Address 1 0 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012697 <br /> Facility Name CALIFORNIA WATER SERVICE STA 68 <br /> Location BIANCHI RD <br /> STOCKTON, CA 95204 <br /> Phone <br /> Mailing Address 1 <br /> Care of ROSS MOILAN <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002- RLIHSTALLER, LARRY Fax <br /> APN 10421037 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CALIFORNIA WATER SERV STA 68 <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0021134 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name CALIFORNIA WATER SERVICE STA 68 (Circle One) <br /> Account Balance as of 3/9/2011: $0.00 <br /> (Circle One) <br /> Transfer to Activennactve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2221 -USED OIL ONLY-G5 TONS/YR PR0516592 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR0516600 EE0000418-MICHAEL KITH Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPRO531651 Active Y N A I D <br /> 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 <br /> facility or activity will be billed to the party identified as the OWNER on this form. 1 also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State andlor Federal Laws. <br /> APPLICANTS SIGNATURE: <,73;;-;- /�17A"liLti� l�tc c�ie�- (oval Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Reoeiveij by <br /> REHS: Date / / Account out: - Date_ /_10 /-LL— <br /> COMMENTS: <br /> \\ehenv\envision\reports\5021.rpt <br />