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Date run 7/1/2020 11:39:54AM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/1/2020 <br /> Record Selection Criteria: Facility ID FA0018851 <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: 13 SSN/Fed Tax ID <br /> Owner ID OW0002758 New Owner ID <br /> Owner Name PORT OF STOCKTON <br /> Owner DBA <br /> OwnerAddress 2201 W WASHINGTON ST <br /> STOCKTON, CA 95203 <br /> Work/Business Phone Not Specified <br /> Alternative Phone 209-946-0246 <br /> Mailing Address PO BOX 2089 <br /> STOCKTON, CA 952012089 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0018851 <br /> Facility Name PORT OF STOCKTON-ROUGH & READY ISI <br /> Location 2201 WASHINGTON ST <br /> STOCKTON, CA 95203 <br /> Phone <br /> Mailing Address PO BOX 2089 <br /> STOCKTON, CA 95201 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, MIGUEL Fax <br /> APN 14503001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0033502 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ENVIRONMENTAL RISK SERVICES CORP (Circle One) <br /> Account Balance as of 7/1/2020: $0.00 C <br /> QDw "`G w�� �� �f�, t i L (Circle One) <br /> ah Z2o1 "v L�'•��� l� . T nsferto Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status ew Owner? D <br /> elete <br /> 2960-RWQCB LEAD AGENCY CLEAN UP SITE PR0527808 EE0000997-HARLIN KNOLL Active Y N A D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHS/EHD 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 andlor Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$25.00= ount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received b <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> Invoice#: <br />