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Date run 3/9/2011 3:33:13PMSAN JO° —LTIN COUNTY <br /> .ENVIRONMENTAL HEA'. —4 DEPARTMENT Y Report#5021 <br /> !''r Pagel <br /> Run by 4006 Facility Information as'of 319120- ' <br /> Record Selection Criteria: Facility ID FA0009705'_' <br /> 'Make changes/corrections in RED ink. <br /> RLEINFORMATION CHANGE(date) <br /> - OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN 1 Fed Tax ID <br /> . Owner ID OW0003627 New Owner ID <br /> Owner Name CALIFORNIA WATER SERVICE <br /> Owner DBA CALIFORNIA WATER SVC - PRIMARY <br /> Owner Address 1720 N FIRST'ST <br /> SAN JOSE, CA 95112 <br /> Home Phone 800-750-8200 ' ,�, - <br /> 04 31Vf <br /> WorklBusiness P - <br /> Mailing:A1dress 1 00 <br /> Care of _ IGS 7�� f <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009705 <br /> Facility Dame CALIFORNIA WATER SVC -21-01 <br /> Location 3115 SANGUINETTI LN <br /> STOCKTON, CA 95205 <br /> li. Phone 1 <br /> Mailing Address 1 STE <br /> Care of ROSS MOILAN k` <br /> I. Location Code Alt Phone <br />'I <br /> B05 District . .ra_ Fax x <br /> APN 117-080-13 Email .. el <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION . <br /> Contact Name ' <br /> Title �r _ <br /> 1 Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016705 ;it: - ra New Account ID:f: <br /> Mail Invoices to Facility .,Mail Invoices to: Owner 1'�Facility 1. Account <br /> Account Name CALIFORNIA WATER SVC -21-01 (Circle One) <br /> Account Balance as of 31912011: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br />( <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner> Delete <br /> t, 2221 -USED OIL ONLY-<5 TONSIYR PR0513995 EE0004636-GARRETT BACKUS Active Y N A I D <br />< 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0511993 EE0000000-HAZ MAT SJC OES Inactive Y. N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR1PR0509705- EE0000000-HAZ MAT SJC OESInactive J Y' N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0528336 EE0004636-GARRETT BACKUS Active,Exempt Y -N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0531804 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 spec,PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form..I also oert'dy that all operations will be performed in accordance with all applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. _n <br /> APPLICANT'S SIGNATURE., � � tate 1 I <br /> Program Records to be TRANSFERED: *$25:00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: �.Amount Paid Date <br /> .Payment Type Check Number Received by <br /> REHS: Dale 1 I Account out: Date _Jl _ <br /> COMMENTS: <br /> F11eh-envlenvisionlreports15021.rp# <br />