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Dale run 2/10/2016 8:21:58AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Repast#5021 <br /> Run by Pagel <br /> Facility Information as of 2/10/2016 <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 /> OwnerAddress 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 Servic( <br /> Moon Township, PA 15108 <br /> Care of FedEx Ground- Stockton <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS 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 AR0037837 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Debra Gehm (Circle One) <br /> Account Balance as of 2/10/2016: $503.00 <br /> (Circle One) <br /> Transfer to Active4nactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO539793 EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO537866 EE0001421 -STACY RIVERA 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 ACRNOWLEDGEMENTI,the undersigned owner,operator or agent of same,acknowledge that all site,anclor project specific,PHS/EHD hourly charges associatedwdh thiafadlity <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 andfor Standards and State and'" <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date I / <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: Invoice 1f: <br />