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Date run 3/6/2012 1:46:31PM SAN JOWINCOUNTY ENVIRONMENTAL HE DEPARTMENT Report#5021 <br /> Run by r .. ! <br /> Facility Information as of 3/6/20 Pagel <br /> Record Selection Criteria: Facility ID FA0010925 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) 1 Zi <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008925 Case Number: H08982 New Owner ID <br /> Owner Name CBS OUTDOOR <br /> Owner DBA CBS OUTDOOR <br /> Owner Address 2050 W FREMONT ST <br /> STOCKTON, CA 95203 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address <br /> ST V\ (J ��45) <br /> Care of FORREST PORTER <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010925 <br /> Facility Name CBS OUTDOOR <br /> Location 2050 W FREMONT ST <br /> STOCKTON, CA 95203 <br /> Phone 209-466-5022 <br /> Mailing Address-2Qsn 1A/ EREMON1S4; <br /> S 5203 ` <br /> Care of FORREST PORTER R?vo?,cYUw Vl L� C(OSS—O UB <br /> Location Code 01 -STOCKTON Alt Phone—� <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 13336031 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name FORREST PORTER <br /> Title OPERATIONS MANAGER <br /> Day Phone 209-466-5021 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017925 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name CBS OUTDOOR -fir VYSL1^ LZ (Circle One) <br /> Account Balance as of 3/6/2012: $0.00 <br /> (Circle One) <br /> Program/Element and Description Record ID Employee ID and NameStatus Transfer to Active/Inaclve <br /> New Owner' Delete <br /> 2220-SM HW GEN<5 TONSNR PR0514454 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0513213 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0520553 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR PR0510925 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0533531 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned!owner,operator or agent of same,acknowledge that all she,and/or pmject specific,PHS/EHD 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 mat all operations will be performed in accordance with all applicable Ordmace Codes andior Standards and <br /> State andror Federal Laws. <br /> APPLICANTS 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 Check Number Received by <br /> REHS: Date /_/_ Account out: Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt w\ZL\vi '��1 <br /> Z <br />