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DatEjun 3/2/2010 2:12:57PM SAN J01UIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> Run b3 4006 Pagel <br /> Facility Information as of 3/2/20 <br /> Record Selection Criteria: Facility ID FA0009487 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0007487 Case Number: H04493 New Owner ID <br /> Owner Name UNIVERSITY OF THE PACIFIC <br /> Owner DBA UNIVERSITY OF THE PACIFIC MAIN <br /> Owner Address 3601 PACIFIC AVE <br /> STOCKTON, CA 95211 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-946-2222 <br /> Mailing Address 3601 PACIFIC AVE <br /> STOCKTON, CA 95211 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009487 <br /> Facility Name UNIVERSITY OF THE PACIFIC <br /> Location 3601 PACIFIC AVE <br /> STOCKTON, CA 95211 <br /> Phone 209-946-2222 <br /> Mailing Address 3601 PACIFIC AVE <br /> STOCKTON, CA 95211 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 11314006 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016487 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name UNIVERSITY OF THE PACIFIC (Circle One) <br /> Account Balance as of 3/2/2010: $2,410.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner.) Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511775 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PRO514597 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2228-GEN 25<50 TONS PERMIT PR0513865 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0519676 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR1PR0509487 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATRPR0526392 EE0004636-GARRETT BACKUS Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO532950 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 specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identied as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: ` T�C��� Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: $372.00= Amount Paid Date <br /> Payment Type Check Number Received by n <br /> RENS: Date - 012,L Account out: Date 3 / y /4 <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />