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[Record <br /> Irun9/8/200911:01:57AM SANr QUIN COUNTY ENVIRONMENTAL HE. H DEPARTMENT Report#5021 <br /> Facility Information as of 9/8/2009 Page' <br /> Selection criteria Facility ID FA0010368 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> Owner ID OW0008368 Case Number: H07889 New Owner ID <br /> Owner Name SAN JOAQUIN COUNTY <br /> Owner DBA <br /> Owner Address 5000 S AIRPORT WAY p <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-468-4722 <br /> aiding Address 5000 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010368 <br /> Facility Name SJC DEPT OF AVIATION <br /> Location 7422 S LINDBERGH ST Z <br /> STOCKTON, CA 95206 <br /> Phone 209-468-4700 <br /> Mailing Address 5000 S AIRPORT WAY RM 202 QK <br /> ~ STOCKTON, CA 95206 <br /> Care of JAMES L DAVIS LZ S f-I e r<:- <br /> Location Code Alt Phone <br /> BBS District Fax <br /> APN 177-260-09 EMail �2�rv�� 'ice OIC-11 S —T—,%.,p� <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name r <br /> Title <br /> Day Phone <br /> Night Phone �'R 7 l ` <br /> ACCOUNTS RECEIVABLE FILE INFORMATION 'T <br /> Account ID AR0017368 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to Owner f Facility 1 Account <br /> Account Name SJC DEPT OF AVIATION (Circle One) <br /> Account Balance as of 91812009: $0.00 <br /> (Circle One) <br /> Transfer to Aclivellnactve <br /> ProgramiElement and DescriptionRecord ID Employee ID and Name Status New Owner? Delete <br /> 2221 -USED OIL ONLY-<5 TONS/YR PR0514298 EE0002670-MUNIAPPA NAIDU Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOtPR0512656 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPRO510368 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2831 -AST FAG >/= 1,320-<10 K GAL CUMULATI1PR0515686 EED002670-MUNIAPPA NAIDU Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that ail site,and/or project specific,PHSlEHD hourly charges associated with this <br /> facility or actively 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 Ordinace Codes andlor Standards and <br /> Slate and/or Federal Laws, <br /> APPLICANT'S SIGNATURE: Date ! 1 <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date / 1 <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date 1 I <br /> Payment Type Check Number Received b <br /> REHS: ? fj'lryji! pate 1 1 O 7 Account out: Date <br /> COMMENTS: <br /> \leh-envlenvi sionlreports15021.rpt <br />