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e <br /> Date run 5/22/2014 1:33:42Ph SAN J UIN COUNTY ENVIRONMENTAL HEM DEPARTMENT Report 115021 <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 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 FERY ROAD, C-19 <br /> ATLANTA, GA 30339 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0013652 10140229 <br /> Facility Name HOME DEPOT#1022 <br /> Location 5010 FEATHER RIVER DR <br /> STOCKTON, CA 95219 <br /> Phone 209-474-8285 <br /> Mailing Address 3207 GREYHAWK CT, ST 00 <br /> CARLSBAD, CA 9 <br /> Care of 3E COMTON EGULATORY DEPT <br /> Location Code 01 -ST Alt Phone <br /> BOIS District 00 ESTOLARIDES Fax <br /> APN 11619008 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 AR002 809 New Account ID: <br /> Mail Invoices to FaMail Invoices to: Owner / Facility / Account <br /> Account Name HOME DEPOT#1022 Circle One) <br /> Account Balance as of 5/22/2014: $0.00 (Circle One) <br /> Transfer to ActiveJlnaclve <br /> Program/Element and Description <br /> Record ID Employee ID and Name Status New Omer? Delete <br /> 1620-RETAIL MKT 26-300 SQ FT(INCIDENTAL FOOD: PRO526582 EE0006213-VIDAL PEDRAZA Inactive Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PRO521070 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0518008 EE0005642-MICHELLE HENRY Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0518009 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0518010 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534503 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,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 1 also certify that all operations will be performed in accordance with all applicable Ordinance Codes ander Standards and State ander <br /> Federal Laws. <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: ,Wn <br /> Y��� <br />