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*kms - 3/25/2014 3:36:50PR SAN JC�JIN COUNTY ENVIRONMENTAL HEA�� DEPARTMENT Repan#5021 <br /> Run by r Pagel <br /> Facility Information as of 3/25/2014 <br /> Record Selection Cabana Facility ID FA0018396 <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: 2 SSN/Fed Tax ID <br /> Owner ID OW0015115 New Owner ID <br /> Owner Name WEYERHAEUSER <br /> Owner DBA WEYERHAEUSER <br /> Owner Address 1111 HUMPHREYS AVE <br /> STOCKTON, CA 95203 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-942-1825 <br /> Mailing Address !ill HUM-PHREYS-AVE_ a ]p0 S- cod"Airf A l0..S t <br /> o�1��rn� C0. otSZO <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0018396 10,186,863 <br /> Facility Name WEYERHAEUSER <br /> Location 1111 HUMPHREYS AVE <br /> STOCKTON, CA 95203 <br /> Phone 209-942-1825 x0 <br /> Mailing Address Qa7O0 S. ��, (Y\�G... � eeA- <br /> 03 S1 p h / A- K-Zu � <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOB District 001 -VILLAPUDUA Fax <br /> APN 16203007 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 AR0032443 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name WEYERHAEUSER (Circle One) <br /> Account Balance as of 3/25/2014: $363.00 <br /> (Circle One) <br /> Transfer to Activelinactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PRO527137 EE0009817-ROBERT LOPEZ Active Y N A 1 D <br /> 2220-SM HW GEN<5 TONS/YR PR0537815 EE0001421 -STACY RIVERA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO533664 Inactiv[ Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific.PHSEHD hourlycharges essociatedwith this facility <br /> or activity will be billed to the party idenlitied as the OWNER on this fano. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes amYor Standards and State andor <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 Type Check Number Received by <br /> REHS: Date / I Account out: Data c3 / /d <br /> COMMENTS: <br />