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y <br /> Dale am 216/2018 8:08:47AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repos#5021 <br /> Run by Papel <br /> Facility Information as of 716/2018 <br /> Record Sekcfion Cntiam: Fl ID FA0002435 <br /> Make changes corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE����((/ <br /> <br /> Owner ID OWOOO1860 New Owner ID <br /> Owner Name AMERICAN RED CROSS <br /> Owner DBA <br /> Owner Address 65 N COMMERCE ST <br /> STOCKTON, CA 95202 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-943-3830 <br /> Mailing Address 3131 N VANCOUVER AVE 1,rocs Tiq <br /> PORTLAND, OR 97227-1560 PlImo 0. _ !•f[ / <br /> Care of AMERICAN RED CROSS <br /> FACILITY FILE INFORMATION <br /> Faciltly ID/CERs ID FA0002435 10180929 <br /> Facility Name Americam-Red G*Dss C ka Io0 <br /> Location 65 N COMMERCE ST <br /> STOCKTON, CA 95202 <br /> Phone 888-942-2566 x <br /> Mailing Address 65 N COMMERCE ST GG 24r0.. <br /> STOCKTON, CA 95202 &m o rl.A.) '�+ 11., K <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone ' <br /> SO$District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 13728012 EMall: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name QA MANAGER <br /> Title <br /> Day Phone 209-235-9976 x220 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0004593 New Account ID: : <br /> Malllnvoicesto ACCOUnt Mall Invoices to: Owner / Facility / Account <br /> Account Name American Red Cross (Clyde one) <br /> Account Balance as of 2/6/2018: $1,321.60 <br /> (Cirde One) <br /> Transfer fo Pctivepnadve <br /> PrcpraMElemenl and Descjellnn Rernrd ID Employee need Name Slot" Neer Ovanr7 Delete <br /> 1921 -HMBP-Regular-Primary Location PRO630821 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO518109 EE0001421-STACY RIVERA Active Y N A 1 O <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO518110 EE9999998-ONE VACANTI Inactive Y N A 1 D <br /> 4530-LG QUANITY GENERATOR PR0450112 EE0003973-ROBERT MCCLELLON Active Y N A I D <br /> 4557-MED WASTE LIMITED HAULER PRO505421 EE0003973-ROBERT MCCLELLON InadNe Y N A 1 D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PROS31672 Inadivc Y N A 1 D <br /> Ru INC,and COMPLIANCE ACKNOWLEDGEMENT: I,pv undvne;,ad ewner,oparoW or spent rn carne,ackrnvledpe Nal 0 cite, Nia letAly <br /> orl.eFederal <br /> el yell be bllkd lolMpally tlenaTred es Me OWNERon I:Msaxm IaleocMAy lhel ell vpereliona�vdl he performed MaccnNarce xilh all epplicaNs Ortnarlce Codesandar&HntlartlsaM Slate soda <br /> Lsvv <br /> APPLICANTS SIGNATURE: '. I(.� L � Dah <br /> Program Records to he TRANSFERED: '$25.00= Amount Paid Date—/ <br /> Water System to be TRANSFEREO: Amount Paid Date^/T/ <br /> Payment Type Check Number Received y <br /> EHD Staff: Date I / Account out: Date <br /> COMMENTS: <br /> Invoice>F: <br />