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Date run 12/20/2016 4:22:15F SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/20/2016 <br /> Record Selection Criteria: Facility ID FA0023798 <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 OW0022161 New Owner ID <br /> Owner Name Pacific Bell Telephone Company dba AT&T Cz <br /> Owner DBA <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone 214-741-0460 <br /> Mailing Address 308 S. Akard St., 17th Floor <br /> Dallas, TX 75202 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0023798 10676599 <br /> Facility Name AT&T California -SKTNCA00075 <br /> Location 9300 N West Ln <br /> Stockton, CA 95210 <br /> Phone 800-335-6088 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 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 AR0044073 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name AT&T EH&S (Circle One) <br /> Account Balance as of 12/20/2016: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0541513 EE0000006-HAZA SAEED Active 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 and/or <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 C k umber Received by / <br /> EHD Staff: 4 Date�/ /� Account out: 16 Date / /I <br /> COMMENTS: <br /> Invoice#: <br /> C <br /> << CA"Cal - <br />