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Date run 11/10/2017 2:53:02PSAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 11/1012017 <br /> Record Seledion Criteria: Facility ID FA0007076 <br /> Make changeslcorrections 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 OW0012706 New Owner ID <br /> Owner Name REGAL CINEMAS INC <br /> Owner DBA <br /> OwnerAddress 7132 REGAL LN <br /> KNOXVILLE, TN 37918 <br /> Home Phone 865-922-1123 <br /> Work/Business Phone 209-461-0356 <br /> Mailing Address 7132 REGAL LN <br /> KNOXVILLE, TN 37918 <br /> care of REGAL CINEMAS INC <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0007076 10182179 <br /> Facility Name STOCKTON HOLIDAY CINEMAS#8 <br /> Location 6262 WEST LN <br /> STOCKTON, CA 95210 <br /> Phone 209-955-5683 x <br /> Mailing Address 6262 WEST LN <br /> STOCKTON, CA 95210 <br /> Care of REGAL CINEMAS INC <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 002- MILLER, KATHERINE Fax <br /> APN 09434001 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name CLIFF CHADWELL <br /> Title <br /> Day Phone 209-955-5683 <br /> Night Phone 865-925-9494 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0010235 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility ! Account <br /> Account Name REGAL CINEMAS INC (Circle One) <br /> Account Balance as of 11/10/2017: $0.00 <br /> (Circle One) <br /> Transferto Adivennacive <br /> fi�+�rograno Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1(ft` -FOOD EST<500 SO FT W/O SEATING PR0505909 EE0009488-JEFFREY WONG Active Y N A I D <br /> 1 1 -HMBP-Regular-Primary Location PR0520834 EE0008709-JAMIE LIMA Active Y N A I D <br /> 224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO515851 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FI PRO515852 EE0000149-RAYMOND BORGES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532843 Inactive Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project spade,PHSIEHD hourly charges associated won 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 /> 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 Tyge, Check Number Received b <br /> EHD Staff: I ` Date Account Account out: Date ! /Invoice ,�" <br /> COMMENTS: <br /> �U,S1rie�S dt�v�e� �P�n �'i-rmn iv\Jzn� t >1oj 0. COZ 01-, #: <br />