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Date rue . 8/2?W2015 3:30:51Pn SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 8/25/2015 <br /> Record Selection Critena: Facility ID FA0015095 <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: 3 SSN/Fed Tax ID <br /> Owner ID OW0002203 New Owner ID <br /> Owner Name TOYS R US <br /> Owner DBA TOYS R US <br /> Owner Address 225 SUMMIT AVE <br /> MONTVALE, NJ 076451523 <br /> Home Phone Not Specified <br /> Work/Business Phone 973-617-3500 <br /> Mailing Address 1 GEOFFREY WAY <br /> WAYNE, NJ 07470-2030 <br /> Care of TAX DEPT <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0015095 <br /> Facility Name TOYS R US <br /> Location 718 W HAMMER LN <br /> STOCKTON, CA 95210 <br /> Phone 209-473-9878 <br /> Mailing Address 718 W HAMMER LN <br /> STOCKTON, CA 95210 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002-MILLER, KATHERINE Fax <br /> APN 08102014 EMajl: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name TOYS R US <br /> Title <br /> Day Phone 209-473-9878 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025876 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name TOYS R US (Circle One) <br /> Account Balance as of 8/25/2015: $0.00 <br /> (Circle One) <br /> Transfer toActiveloacive <br /> ProgranvElemenl and Description Record ID Employee ID and Name Status New Ownea Delete <br /> 1618-RETAIL MKT>2000 SO FT (PREPKGD/LTD PRE PRO522142 EE0003361 -MARIBEL FLOHRSCHUTZ Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andror project speolfc,PHSEHD hourly charges associated with this fadliry <br /> wadivitywill be billed to the parry identified as the OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes anNcr Standards and State andfor <br /> Federal Lewis <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 Type Check Number Received by <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS'. <br /> I^} / Invoice#: <br />