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Date run 7/2/2013 8:46:49AM SAN JOAOIN COUNTY ENVIRONMENTAL HEAI*DEPARTMENT Report#51321 <br /> Run by Pagel <br /> Facility Information as of 7/2/2013 <br /> Record Selection Criteria: Facility ID FA0014912 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011052 New Owner ID <br /> Owner Name KIMCO REALTY CORP <br /> Owner DBA KIMCO REALTY CORP <br /> Owner Address 5238 MANZANITA AVE <br /> CARMICHAEL, CA 95608 <br /> Home Phone 916-349-7480 <br /> Work/Business Phone Not Specified <br /> Mailing Address 5238 MANZANITA AVE <br /> CARMICHAEL, CA 95608 <br /> Care of LARRY LIPP <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0014912 <br /> Facility Name COSTCO WHOLESALE <br /> Location 1616 E HAMMER LN <br /> STOCKTON, CA 95210 <br /> Phone <br /> Mailing Address 999 LAKE DRIVE <br /> ISSAQUAH, WA 98027 <br /> Care of DENNIS BOCK <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DENNIS BOCK <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0025442 New Account ID: <br /> Mail lnvoicesto Account Mail Invoices to: Owner / Facility / Account <br /> Account Name KLEINFELDER INC (Circle One) <br /> Account Balance as of 7/2/2013: $-250.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0621933 EE0000997-HARLIN KNOLL Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anNor project specific,PHS/EHD hourly charges assoaatetl 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 al Standards and State and'or <br /> Federal Laws. <br /> APPLICANT'S 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 /> REHS: Date / / Account out: Date / / <br /> COMMENTS: <br />