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Dale run 2/17/2017 10:32:57At SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> Run by Report e5021 <br /> Facility Information as of 2/17/2017 Pagel <br /> Record Selection Criteria: Facility ID FA0021024 <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 OW0017303 New Owner ID <br /> Owner Name FedEx Ground Packages System, Inc. <br /> Owner DBA FEDEX HOME GROUND <br /> OwnerAddress 1000 FEDEX DR <br /> MOON TOWNSHIP, PA 15108 <br /> Home Phone 412-262-7306 <br /> Work/Business Phone 412-262-6291 <br /> Mailing Address 1000 FedEx Drive <br /> Moon Township, PA 15108 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021024 10445788 <br /> Facility Name FedEx Ground - Stockton <br /> Location 4730 Fite Ct <br /> Stockton, CA 95215 <br /> Phone 209-460-0845 x <br /> Mailing Address 1000 FedEx Drive,Attn: Environmental Service <br /> Moon Township, PA 15108 <br /> Care of FedEx Ground-Stockton <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone '\YI <br /> ACCOUNTS RECEIVABLE FILE INFORMAT N <br /> Account ID AR003783 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name FED GROUND-STOCKTON (Circe One) <br /> Account Balance as of 2/17/20 : $555.00 <br /> (Circle One) <br /> Transfer to AciveJlnaclve <br /> Program clement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0539793 EE0008709-JAMIE LIMA Active Y N AD <br /> 2220-SM HW GEN<5 TONS/YR PR0537866 EE9999996-THREE VACANT3 Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0536615 EE0002620-ALFONSO ARAMBULA Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT'. I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSEHD hourly charges associated with this facility <br /> 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 Ordinance Codes andor Standards and Slate andor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: •$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> PaymentTripe Check Number Received b L <br /> EHDStaff: t�� Q.c Date /—E /_"7_ Account out: Date <br /> COMMENTS: (� / <br /> IRS per �l &r Peal f,< �o u� "0 Lovjtr in �pci-tt{ I ce#: <br /> hid lnpwlwvc maved -b 15U55 ROC6 w4 I VB'T►rrAj_�. 0 percL0. " ul erre, 5 by ped <br /> g (?w(l 1 <br />