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Date run 9/3/2015 1:08:17PM SAN JC�UIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Repo^M21 <br /> Run by Pagel <br /> Facility Information as of 9/3/2015 <br /> Record Selection Criteria: Facility ID FA0010345 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 6 SSN/Fed Tax ID : <br /> Owner ID OW0008345 Case Number: H07812 New Owner ID <br /> Owner Name The Home Depot U.S.A., Inc. <br /> Owner DBA HOME DEPOT <br /> Owner-Address 2455 PACES FERRY RD <br /> ATLANTA, GA 30339 <br /> Home Phone Not Specified <br /> Work/Business Phone 770-433-8211 <br /> Mailing Address 2455 Paces Fery Road, C-19 <br /> Atlanta, GA 30339 <br /> Care of COMPLIANCE DEPT <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERSID FA0010345 10140205 <br /> Facility Name THE HOME DEPOT STORE#0662 <br /> Location 3818 E Hammer Ln <br /> Stockton, CA 95212 <br /> Phone 209-476-9600 x <br /> Mailing Address 3818 E Hammer Lane <br /> Stockton, CA 95212 <br /> Care of The Home Depot U.S.A., Inc. <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002 -MILLER, KATHERINE Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017345 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ARCADIS U.S., Inc. (Circle One) <br /> Account Balance as of 9/3/2015: $0.00 <br /> (Circle One) <br /> ProgmnVElement and Description Recwtl ID Empbyee ID antl Name Status Transfer to ActivOnacwe <br /> New Owner? Delete <br /> 1620-RETAIL MKT 26-300 SO FT(INCIDENTAL FOODS PRO526579 EE0009488-JEFFREY WONG Active Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PR0520253 EE0000006-HAZA SAEED Active Y N A I D <br /> 220-SM HW GEN<5 TONSNR PRO517913 EE0005642-MICHELLE HENRY Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512633 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510345 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534193 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge Nat all site,andor Project specific,PHSEHD hourly charges associated with this facility <br /> or activity will W billed to the party identified as the OWNER m this form. I also candy that all operations will be performed in accordance with all applicable Ordinance Codes ardor Standards and State 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 /> Payment TypeJ, Check Number Received by <br /> EHD Staff: v l�7Z t Date _/�� Account out: Date�/ / D l l� <br /> COMMENTS: <br />