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Date run 3/9/2011 3:33:22PM SAN J6t—UIN COUNTY ENVIRONMENTAL 11EAI LI DEPARTMENT Report#5021 <br /> Pagel <br /> Run by 4006 ' ;Facility Information as of 319120 ' " `' <br /> C - <br /> Record Selection Criteria: Facility ID FA0009707" <br /> Make changes/corrections in RED ink. <br /> FIL <br /> :INFORMAT <br /> N CHANGE(date)E <br /> OWNERSIOP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/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 /> Work/Busj -BQ �� to l <br /> Mailing Address 1 ST„ ST 00 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009707 <br /> Facility Name CALIFORNIA WATER SVC -79-01 <br /> Location 2933 W ILCOX RD <br /> STOGKTON, CA 95215 <br /> Phone !t <br /> i <br /> . Mailing Address t55VVrI=�'R'EW <br /> Care of ROSS MOILAN " <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 002- RUHSTALLER, LARRY ¢- Fax I: <br /> APN 08710056 Entail: 0, <br /> "EMERGENCY NOTIFICATION CONTACTINFORMATION <br /> Contact Name ' x <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016707 New Account ID:- <br /> Mail Invoices to.Facility ' Mail Invoices to: Owner /. Facility ! Account <br /> Account Name CALIFORNIA WATER SVC.- 79-01 (cire°"e) <br /> Account Balance as of 31912011:k$OAO .. <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2221 -USED OIL ONLY-<5 TONS/YR PR0513997 ' EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511995 EE0000000-HAZ MAT SJC IDES Inactive k Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARPR050007 . EE0000000-HAZ MAT SJC IDES s Inactive Y"" N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL' PRO528338 EE0004636-GARRETT BACKUS Active,Exempt Y, N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0534123 y Active Y 3' N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that alt site,and/or project spec,PHSlEHD hourly charges associated with this <br /> facility 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 Ordinace Codes andlor Standards and <br /> State andfor Federal Laws. <br /> APPLICANT'S SIGNATURE: /�T 1D 7�+�'— .6V022). Date 3 1 1 1 �l <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid Date I I <br /> Water System to be TRANSFERED: Amount.Paid Date / 1 <br /> Payment Type Check Number Received by <br /> REHS: Date I I Account out: Date 3 l /Q_l _ <br /> COMMENTS: <br /> Ileh-envlenvisionlreports15021.rpt' <br />