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Date run 10/16/2009 3:36:18P SAN JO/" IN COUNTY ENVIRONMENTAL HEAL�EPARTMENT Report#5021 <br /> Run by ��/ Paget <br /> Facility Information as of 10/16/2009 <br /> Record Selection Criteria: Facility ID FA0019894 <br /> Make changes/corrections in RED ink. <br /> ELMO INFORMATION CHANGE(date) <br /> �..• OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> SSN I Fed Tax ID <br /> Owner ID OW0002112 New Owner ID <br /> Owner Name SJC DELTA COLLEGE <br /> Owner DBA SAN JOAQUIN DELTA COLLEGE <br /> Owner Address 5151 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-954-5151 <br /> Mailing Address 5151 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0019894 <br /> Facility Name SJ DELTA COLLEGE - SHIMA AG <br /> Location 5151 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Phone 209-954-5835 <br /> Mailing Address 5151 PACIFIC AVE <br /> STOCKTON, CA 95207 <br /> Care of PINOLA, STACY <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 10816001 EMail : <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION � <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account 1D AR0035466 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner I Facility I Account <br /> Account Name SJ DELTA COLLEGE- SHIMA AG (Circle One) <br /> Account Balance as of 1011612009. $- .00 <br /> (Circle One) <br /> Transferto Aativellnactve <br /> ProgramfElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PRO530688 EE0000694-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSlEHD hourly charges associated with this <br /> facility 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 Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: *$372.00= Amount Paid Date I 1 <br /> Payment Type Check Number Received by <br /> REHS: Date 1 1 Account out: Date C> <br /> COMMENTS: <br /> W 6 6 <br /> C <br /> lleh-envlenvisionlreports15021.rpt <br />