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Date run 2/17/2017 10:32:57AP SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report 05021 <br /> Run by Pagel <br /> Facility Information as of 2/17/2017 <br /> Record Selection Criteria: Facility ID FA0021024 <br /> Make changesicorrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID : <br /> Owner ID OW0017303 New Owner ID <br /> Owner Name FedEx Ground Packages System, Inc. <br /> Owner DBA FEDEX HOME GROUND <br /> Owner Address 1000 FEDEX DR <br /> MOON TOWNSHIP, PA 15108 <br /> Home Phone 412-262-7306 <br /> Work/Business Phone 412-262-6291 <br /> Mailing Address 1000 FedEx Drive <br /> Moon Township, PA 15108 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0021024 10445788 <br /> Facility Name FedEx Ground - Stockton <br /> Location 4730 Fite Ct <br /> Stockton, CA 95215 <br /> Phone 209-460-0845 x <br /> Mailing Address 1000 FedEx Drive,Attn: Environmental Service <br /> Moon Township, PA 15108 <br /> Care of FedEx Ground -Stockton <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOIS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone \ <br /> Night Phone � 'Xl <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0037837' New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name FEDE GROUND-STOCKTON (Circle One) <br /> Account Balance as of 2/17/20 : $555.00 <br /> (Circle One) <br /> Transfer to Adivee <br /> Program/Element and Description Recortl ID Employee ID and Name status New OwnaR Delete <br /> 1921 -HMBP-Regular-Primary Location PR0539793 EE0008709-JAMIE LIMA Active Y N AD <br /> 2220-SM HW GEN c5 TONS/YR PR0537866 EE9999996-THREE VACANT3 Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0536615 EE0002620-ALFONSO ARAMBULA Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,anclor project specific,PHSEHD hourly charges associated with this facility <br /> or activity will be billed to the party identi5ed as the OWNER an this form. I also certify that all operations will W performed in accordance with all applicable Ordinance Codes and(or Standards and State anoor <br /> 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 Twe Check Number Received L <br /> EHD Staff: Date-2--/—L3--/—q-- b Account out: Date <br /> COMMENTS: _rr 1 <br /> ce III <br /> Os per Ca d CIT fed � �aCU� +y h0 6(f1`GSP,t^ i n O}U'�iI{-►l # <br /> �u�ihe8s haS moved -b 5u55 400 w4 o perawmi were sWped <br /> FlU14 . <br />