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Date ren 7/18/2013 10:10:58AI SAN JOMQ N COUNTY ENVIRONMENTAL HEAL... Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/18/2013 <br /> Record Selection Criteria: Facility ID FA0021701 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0017861 New Owner ID <br /> Owner Name PPC STOCKTON PLAZA LP <br /> Owner DBA STOCKTON PLAZA <br /> Owner Address 4153 GREENVIEW DR <br /> ELDORADO HILLS, CA 95762 <br /> Home Phone 916-489-9931 <br /> Work/Business Phone Not Specified <br /> Mailing Address 1820 PROFESSIONAL DR#1 <br /> SACRAMENTO, CA 95825 <br /> Care of BROWN, MICHAEL <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility lD/CERS ID FA0021701 <br /> Facility Name STOCKTON PLAZA <br /> Location 2339 W HAMMER LN STE F <br /> STOCKTON, CA 95209 <br /> Phone 916-489-9931 <br /> Mailing Address 1820 PROFESSIONAL DR STE 1 <br /> SACRAMENTO, CA 95825 <br /> Care of SMI COMMERCIAL MANAGEMENT <br /> Location Code Alt Phone <br /> BOS District Fax <br /> APN EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name MICHAEL BROWN <br /> Title <br /> Day Phone 916-489-9931 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0039373 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name STOCKTON PLAZA (Circle Ore) <br /> Account Balance as of 7/18/2013: $-187.50 <br /> (Circle One) <br /> Transfer fo Activenni <br /> ProgranyElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0537668 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,she undersigned owner,operator or agent of same,acknowledge that all site,and'or project specific,PHSIEHD 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 anNor Standards and State anNor <br /> Federal Laws <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date I / <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date—/ / Account out: Date_/ I <br /> COMMENTS: <br />