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Date run Y 12/12/2005 1:43:51 F SAN JOA 'iii COUNTY ENVIRONMENTAL HEAT" "DEPARTMENT Report#5021 <br /> Run b�'- r. Pagel <br /> Facility Information as of 12/1212 <br /> Record Selection Criteria: Facility ID FA0003761 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0000781 New Owner ID <br /> Owner Name ST JOSEPHS REGIONAL HOUSING CO <br /> Owner DBA ST JOSEPHS REGIONAL HOUSING CO <br /> Owner Address 3400 WAGNER HTS <br /> STOCKTON, CA 95209 <br /> Home Phone 209-943-2000 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 213008 <br /> STOCKTON, CA 952139008 <br /> Care of ST JOSEPHS REGINAL HOUSING <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003761 <br /> Facility Name ST JOSEPHS HOSPITAL <br /> Location 1800 N CALIFORNIA ST <br /> STOCKTON, CA 95204 <br /> Phone 209-943-2000 <br /> Mailing Address PO BOX 213008 <br /> STOCKTON, CA 952139008 <br /> Care of RAY MCASTER Mc �►� : S 0.�. <br /> Location Code 01 -STOCKTON APN:12718044 <br /> BOS District 002 - MARENCO, DARIO SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003340 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility 1 Account <br /> Account Name ST JOSEPHS HOSPITAL (Circle One) <br /> Account Balance as of 12/1212005: $582.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgramfElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1626-RESTAURANT/BAR 101 +SEATS PRO160504 EE0003474-CHANDRA VEGA Active Y N A 1 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512004 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2226-CatARP PROGRAM PRO514656 EE0000000-HAZ MAT SJC OES Inactive Y N A 1 D <br /> 2244-PACT TRANSFER RECORD-OES PR0519820 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2247-RCRA GEN 5<25 TONS PRO514003 EE0008373-JOHN JACKSON Active Y N A I D <br /> 2301 -UST STATE SURCHARGE FEE PRO515549 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2361 -UST FACILITY PR0231036 EE0008373-JOHN JACKSON Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPRO507445 EEOOODD08-LETITIA BRIGGS Inactive Y N A I D <br /> 2951 -UGT-CAP PRO010361 EE0000684-MICHAEL INFURNA Inactive Y N A I D <br /> 4522-ACUTE CARE FACILITY PR0450006 EE0000988-KASEY FOLEY Active Y N A I D <br /> 4557-MI=D WASTE LIMITED HAULER PR0522306 EE0008373-JOHN JACKSON Active Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0461082 EE0005838-ADRIENNE ELLSAESSEActive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project specific,PHSIEHD 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 Ordinace Codes and/or Standards and <br /> Slate andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! ! <br /> Program Records to be TRANSFERED: "$20.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date ! 1 <br /> Payment Type Check Number Received by <br /> RENS: Date 1 ! Account out: � Date �'2—1 12/ <br /> COMMENTS: <br /> llphs-ehsq 1-ntlappslenvisionslreports15021.rpt <br />