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Date run 12/7/2015 2:09:56P6 SAN JO IN COUNTY ENVIRONMENTAL,HEA19DEPARTMENT Report V5021 <br /> Run by Pagel <br /> Facility Information as of 12/7/2015 <br /> Record Selection Criteria: Facility ID FA0020540 <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: 1 SSN/Fed Tax ID <br /> Owner ID OW0016882 New Owner ID <br /> Owner Name RR DONNELLEY& SONS <br /> Owner DBA RR DONNELLEY& SONS <br /> Owner Address 3837 PRODUCERS DR <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone 312-326-8000 <br /> Mailing Address 3837 PRODUCERS DR STE 500 <br /> STOCKTON, CA 95206 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0020540 10187631 <br /> Facility Name RR DONNELLEY& SONS <br /> Location 3837 PRODUCERS DR STE <br /> STOCKTON, CA 95206 <br /> Phone 209-983-6700 x0 <br /> Mailing Address 3837 PRODUCERS DR STE 500 <br /> STOCKTON, CA 95206 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 001 -VILLAPUDUA, CARLOS Fax <br /> APN 17728058 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 AR0036744 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility f Account <br /> Account Name RR DONNELLEY & SONS (Circle One) <br /> Account Balance as of 121712015: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee IO and Name Status New Owner? Delete <br /> 1920-HMBP-Common Materials PRO535616 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0535974 InactivE 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.PHSIEHD 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 andior Standards and State andfor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date 1 1 <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date 1 1 <br /> Payment Type Check Number Received by <br /> EHD Staff: Date I 1 Account out: Date ! 1 <br /> COMMENTS: <br /> Invoice#: <br />