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Date run 2/28/2018 8:45:43AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 2/28/2018 <br /> Record Selection Criteria: Facility ID FA0023798 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 SSN 1 Fed Tax ID <br /> Owner ID OW0022161 New Owner ID <br /> Owner Name Pacific Bell Telephone Company i AT&T Ca <br /> Owner DBA <br /> OwnerAddress 308 S AKARD ST FLOOR <br /> DALLAS, TX 75202 <br /> Home Phone Not Specified <br /> Work/Business Phone 214-741-0630 <br /> Mailing Address 308 S.Akard St., 17th Floor <br /> Dallas, TX 75202 <br /> Gare of <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0023798 10676599 <br /> Facility Name AT&T California - SKTNCAU0075 <br /> Location 9300 N West Ln <br /> Stockton, CA 95210 <br /> Phone 209-603-9726 x <br /> Mailing Address 308 S.Akard St., 17th Floor <br /> Dallas, TX 75202 <br /> Care of AT&T California <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0044073 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility I Account <br /> Account Name AT&T EH&S (Circle One) <br /> Account Balance as of 2/28/2018: $0.00 <br /> (Circle One) <br /> Transfer to Active/lnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO541513 EE0008709-JAMIE LIMA Active Y N A 0 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHSJEHO 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 andlor Standards and State andlor <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 Tye Check Number Received <br /> EHD Staff: 'yy\-O� Date ! zy I Account out: 4&Z Date <br /> COMMENTS; <br /> Invoice#: <br /> no ( r�P(rav&fck) <br />