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Date ren 5/22/2014 :34:36PA SAN UIN COUNTY ENVIRONMENTAL HE DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/22/2014 <br /> Record Selection Criteria: 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 SSNIFed Tax ID : <br /> Owner ID OW0008345 Case Number: H07812 New Owner ID <br /> Owner Name THE HOME DEPOT USA, 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 ROAD, C-19 <br /> ATLANTA, GA 30339 <br /> Care of <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 209474-8285 x <br /> Mailing Address 5010 FEATHER RIVE5_QLRWE <br /> STOCKTON, 19 <br /> Care of THEH DEPOT USA, INC. <br /> Location Code TOCKTON Alt Phone <br /> BOS District 003- BESTOLARIDES 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_ NewAccount ID: <br /> Mail Invoices to Fa - Mail Invoices to: Owner / Facility / Account <br /> Account Name HE HOME DEPOT STORE#1022 (Circle One) <br /> Account Balance as of 5/22/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/inaclve <br /> Program/Element and Description Record ID Employee ID and Name Status NewOwner? Delete <br /> 1620-RETAIL MKT 26-300 SQ FT(INCIDENTAL FOODS PR0526582 EE0006213-VIDAL PEDRAZA Inactive Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PR0521070 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO518008 EE0005642-MICHELLE HENRY Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO518009 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO518010 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO634503 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSIEHD 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 andor Standards and State andor <br /> Federal Laws. 72-z lVt`1 <br /> 00 <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 /> Y <br />