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Date run 10/24/2018 1:23:16F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 10/24/2018 <br />Record Selection Criteria: Facility ID FA0018143 <br />OWNER FILE INFORMATION Number of facilities for this owner <br />Owner ID <br />OW0014886 <br />Owner Name <br />Home Depot U.S.A. dba Crown Bolt <br />Owner DBA <br />HOME DEPOT USA INC <br />OwnerAddress <br />501 W CHURCH ST <br />ORLANDO, FL 22385 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />770-433-8211 <br />Mailing Address <br />2455 Paces Ferry Rd, C-19 <br />Atlanta, GA 30339 <br />Care of <br />NewAccountlD: <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0018143 10186781 <br />Facility Name HOME DEPOT USA INC. <br />Location 2055 INDUSTRIAL DR <br />STOCKTON, CA 95206 <br />Phone 404-653-5433 x <br />Mailing Address 160 Chapel Road, Suite 201 c/o Compliance <br />Manchester, CT 06042 <br />Care of The Home Depot U.S.A., Inc. <br />Location Code 01 - STOCKTON <br />Bos District 001 - VILLAPUDUA, MIGUEL <br />APN 17733020 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Alt Phone <br />Fax <br />EMail : <br />Contact Name Frank Prost <br />Title Manager <br />Day Phone 209-234-8930 <br />Night Phone 949-620-0689 <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0031913 �^ <br />NewAccountlD: <br />Mail Invoices to Account �`� 1� Mail Invoices to: <br />Owner / <br />Facility / Account <br />Account Name Home Depot U.S.A. db -a' Crown Bolt <br />(Circle One) <br />Account Balance as of 10/24/2018: $641.00 <br />(Circle One) <br />Transfer to Active/Inactve <br />Program/Element and Description Record ID Employee ID and Name <br />Status <br />New Owner? Delete <br />1921 - HMBP-Reqular-Primary Location PR0526786 EE0009817 - ROBERT LOPEZ <br />Active <br />Y N AI D <br />2220 - SM HW GEN <5 TONS/YR PR0538428 EE0000026 - CESAR RUVALCABA <br />Active <br />Y N A D <br />4740 - WASTE TIRE SITE - EXEMPT PR0535050 EE0002620 -ALFONSO ARAMBULA <br />Inactive <br />Y N A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARGI PR0533466 <br />Inactive <br />Y N A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project specific, PHS/EHD 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 and/or Standards and State andlor <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 y <br />EHD Staff: Date I / _/� Account out: <br />Date <br />/./� <br />COMMENTS: <br />Invoice #: <br />