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Date run 12/31/2013 2:35:57P SAN JOAQ- COUNTY ENVIRONMENTAL HEALTH PARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 12/31/2013 <br />Record Selection Criteria: Facility ID FA0016189 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0013085 <br />Owner Name <br />RECOLOGY STOCKTON INC <br />Owner DBA <br />- SM HW GEN <5 TONSNR PR0526359 EE0001421 - STACY RIVERA <br />Owner Address <br />235 N FIRST ST <br />N <br />DIXON, CA 95620 <br />Home Phone <br />707-698-1578 <br />Work/Business Phone <br />209-465-3009 <br />Mailing Address <br />235 N FIRST ST <br />Active <br />DIXON, CA 95620 <br />Care of <br />A I D <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0016189 10185093 <br />Facility Name RECOLOGY STOCKTON <br />Location 250 PORT RD #23 <br />STOCKTON, CA 95205 <br />Phone 209-465-3009 <br />Mailing Address 235 N FIRST ST <br />DIXON, CA 95620 <br />Care of RECOLOGY STOCKTON INC <br />Location Code 01-STOCKTON <br />BOS District 001 - VILLAPUDUA <br />APN 14503001 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0028312 <br />Mail Invoices to Facility <br />Account Name RECOLOGY STOCKTON <br />Account Balance as of 12/31/2013: $0.00 <br />Program/Element and Description <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 />Record ID Employee ID and Name <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Status New Owner? Delete <br />1921 - HMBP-Regular-Primary Location PR0524098 EE0009817 - ROBERT LOPEZ <br />Active <br />Y <br />N <br />A I D <br />- SM HW GEN <5 TONSNR PR0526359 EE0001421 - STACY RIVERA <br />Active <br />Y <br />N <br />A I D <br />ST FAC 10 K- </=100 K GAL CUMULATIVE PR0528528 EE0001421 - STACY RIVERA <br />4207-XVWASTE <br />Inactive <br />Y <br />N <br />r I D <br />TIRE SITE - EXEMPT PR0524592 EE0009000 - HARPRIT MATTU <br />Active <br />Y <br />N <br />A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR0532619 <br />Inactive <br />Y <br />N <br />A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andlor 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 <br />and State and/or <br />Federal Laws. v ✓ <br />GC"-� 1 <br />APPLICANT'S SIGNATURE: Date <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: _ <br />Payment Type <br />RENS: <br />COMMENTS <br />'161 m <br />(Z\jf ( ' <br />* $25.00 = Amount Paid Date <br />Amount Paid Date <br />Number Receiv y <br />Date � ! / Account out: Date <br />