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Date run 5/8/2017 1:43:19PM SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 5/8/2017 <br />Record Selection Criteria: Facility ID FA0024019 <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 <br />Owner ID OW0022491 <br />Owner Name California Water Service Company <br />Owner DBA <br />Owner Address <br />Home Phone Not Specified <br />Work/Business Phone 408-367-8200 <br />Mailing Address 1720 North First St. <br />San Jose, CA 95112 <br />Care of <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID <br />FA0024019 10733878 <br />Facility Name <br />California Water Service Co. - STK 87 <br />Location <br />2135 Wilcox Rd <br />Stockton, CA 95215 <br />Phone <br />209-464-7900 x <br />Mailing Address <br />1602 E. Layafette St. <br />Stockton, CA 95205 <br />Care of <br />California Water Service Company <br />Location Code <br />BOS District <br />APN <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE 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 />Account ID AR0044578 <br />Mail Invoices to Account Mail Invoices to: <br />Account Name California Water Service Company <br />Account Balance as of 5/8/2017: $0.00 <br />New Account ID: : <br />Owner / Facility / Account <br />(Circle One) <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 PR0541878 EE0008709 - JAMIE LIMA 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 anc➢or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: ' $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date ! 1 <br />Payment Type Check Number Received by <br />EHD Staff: Date <_/ / Account out: 1z Date 51 /1-7 <br />COMMENTS: Invoice #: -�2 /9 -7-51 <br />lug <br />S�F7srPIC . <br />