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Date run 12/27/2017 2:36:57P SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/27/2017 <br /> Record Selection Criteria: Facility ID FA0003825 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 4 SSN/Fed Tax ID <br /> Owner ID OW0002750 New Owner ID <br /> Owner Name California Highway Patrol <br /> Owner DBA CALIFORNIA HIGHWAY PATROL-STKN <br /> OwnerAddress PO BOX 942898 <br /> SACRAMENTO, CA 95804 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-835-2856 <br /> Mailing Address 385 W. Grant Line Road <br /> TRACY, CA 95376 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0003825 10181453 <br /> Facility Name CALIFORNIA HIGHWAY PATROL#265" <br /> Location 3330 N AD ART RD <br /> STOCKTON, CA 95215 <br /> Phone 209-943-8666 x <br /> Mailing Address 3330 N.Ad Art Rd. <br /> Stockton, CA 95215 <br /> Care of Barry Koenig <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 002 - MILLER, KATHERINE Fax <br /> APN Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003413 New Account ID: <br /> Mail Invoices to Account f(�QQ Mail Invoices to: Owner / Facility / Account <br /> Account Name California High Fair�7 Y �� (Circle One) <br /> Account Balance as of 12/27/2017: $ .00 VVV1111 �� <br /> 0 (Circle One) <br /> Transferto Active/Inactve <br /> Program/Element and Description R and 10 Employee ID and Name status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO519593 EE0008709-JAMIE LIMA Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO519194 EE0000031 -ELIANNA FLORIDO Active Y N A q, D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511668 EE0000000-HAZ MAT SJC DES Inactive Y N A Y D <br /> 2361 -UST FACILITY PR0231901 EE0000031 -ELIANNA FLORIDO Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE FE PRO507484 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523797 EE0002620-ALFONSO ARAMBULA Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGE PR0532442 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,ander 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 andor Standards and State andor <br /> 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 /> EHD Staff: Date / /� Account out: Dat12-/ <br /> COMMENTS: 'l/7e —&0' nO 10,-700-f- hOf hazardous ,�}� <br /> // bti GCS/ G Invoice#: <br /> onpIi e , per4pboite onverTa-fibv-1 y✓1441 fi/n /Liurretj, OHP &OV-f-e -73 <br /> and -� � cd.SUre ins cion done 0/7 /a/-719Dr7 <br />