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Dale run 3/8/2019 4:08:25PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 15021 <br /> Run by Papel <br /> Facility Information as of 3/8/2019 <br /> Record Selection Criteria: Facility ID FA0018050 <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: 2 SSN/ ed Tax <br /> Owner ID OW0011570 New 0 <br /> Owner Name ESA P PORTFOLIO OPERATING LEASEE LL ' lq 1 ✓ St --1-�� <br /> Owner DBA EXTENDED STAY AMERICA <br /> OwnerAddress 100 DUNBAR ST Iv <br /> SPARTANBURG, SC 29306 <br /> Work/Business Phone 980-345-1600 <br /> Alternative Phone 209-472-7588 <br /> MailingAddress <br /> PO BOX 49550 T <br /> CHARLOTTE, NC 28277-9550 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0018050 <br /> Facility Name EXTENDED STAY AMERICA#8881 <br /> Location 2526 PAVILION PKWY <br /> TRACY, CA 95304 <br /> Phone 209-832-4700 <br /> Mailing Address PO BOX 49550 <br /> CHARLOTTE, NC 28277-9550 <br /> Care of ESH INC <br /> Location Code 03-TRACY Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 111 0- EMail: <br /> UIXEMERGENCY NOTIFICATION CONTACT INFOR EIVE® <br /> Contact Name ROSA ROJAS, M . 2019 L%— #'Cl y <br /> Title <br /> Day Phone 209-832-4700 MAR 1 <br /> Night Phone GOUNN <br /> SAN autNiEN <br /> ACCOUNTS RECEIVABLE FILE INFORMATION ew t)EPW1VENT <br /> Account ID AR0031747 'jje ' New Account ID: <br /> Mail Invoices to Facility Mail Invoices to! Owner / Facility / Account <br /> Account Name EXTENDED STAY AMERICA#8881 (Circle One) <br /> Account Balance as of 3/8/2019: $-152.00 <br /> (Circle One) <br /> Transfer to ActiveAnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2409-HOTEL/MOTEL>90 PR0526660 EE0002089-OMRAN SOOD Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowlodgo that all site,and/or project speck,PHSIEHD 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 and/or Standards and Stato and/or <br /> Federal Laws, <br /> APPLICANT'S SIGNATURE: Date 03 / // l /1 <br /> Program Records to be TRANSFERED: •$25.0 = Amount Paid Date ! / <br /> Water System to be TRANSFERED: Amount Paid Date / ! <br /> Payment Type Check Number Received by <br /> EHD Staff: Date 1 / Account out: Date- /-;Z'd /d <br /> COMMENTS: <br /> Invoice#: <br />