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Date run 127/2016 10:25:25AI SAN J*UIN COUNTY ENVIRONMENTAL HEAIO DEPARTMENT Report*5021 <br /> Run by Pagel <br /> Facility Information as of 1/27/2016 <br /> Record Selection Gillette: Facility ID FA0013652 <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: 6 SSN/Fed Tax ID <br /> Owner ID OW0008345 Case Number: H07812 New Owner ID <br /> Owner Name The Home Depot U.S.A., Inc. <br /> Owner DBA HOME DEPOT <br /> Owner Address 2455 PACES FERRY RD <br /> ATLANTA, GA 30339 <br /> Home Phone Not Specified <br /> Work/Business Phone 770-433-8211 <br /> Mailing Address 2455 Paces Ferry Rd, C-19 <br /> Atlanta, GA 30339 <br /> Care of COMPLIANCE DEPT <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0013652 10140229 <br /> Facility Name THE HOME DEPOT STORE#1022 <br /> Location 5010 FEATHER RIVER DR <br /> Stockton, CA 95219 <br /> Phone 209-474-8285 x <br /> Mailing Address 5010 Feather River Drive <br /> Stockton, CA 95219 <br /> Care of The Home Depot U.S.A., Inc. <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 003- BESTOLARIDES, STEVE Fax <br /> APN 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 AR0022809 NevvAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Arcadis U.S., INC. (Circle One) <br /> Account Balance as of 1/27/2016: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> ProgamlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1620-RETAIL MKT 26-300 SO FT(INCIDENTAL FOODS; PR0526582 EE0006213-VIDAL PEDRAZA Inactive Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PR0521070 EE0000006-HAZA SAEED Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNFE PR0518008 EE0005642-MICHELLE HENRY Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0518009 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FE PR0518010 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE PR0534503 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andfor project speofic,PHSIEHD hourly charges associated with this facility or e <br /> 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 anNor Standards and State andfor Federal Laws. <br /> APPLICANTS 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 /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> Invoice#: <br />