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Dale run 9/19/2013 11:00:03AI SAN J(� JIN COUNTY ENVIRONMENTAL HEt� f DEPARTMENT Report #5021 <br />Runby .� Pagel <br />Facility Information as of 9/19/2013 <br />Record Selection Criteria: Facility ID FA0006174 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0004923 <br />Owner Name <br />EARTH GRAINS BAKING COMPANIES INC <br />Owner DBA <br />EARTHGRAINS BAKING CO INC THE <br />Owner Address <br />S PO BOX 976 WAY <br />PRO513821 <br />HORSHAM, PA 19044 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address <br />PO BOX 976 <br />EE0000000 - HAZ MAT SJC DES <br />HORSHAM, PA 19044 <br />Care of <br />N <br />FACILITY FILE INFORMATION <br />Facility ID/CERSID <br />FA0006174 10,182,041 <br />Facility Name <br />EARTHGRAINS BAKING CO INC <br />Location <br />2651 S AIRPORT WAY <br />A I C <br />STOCKTON, CA 95206 <br />Phone <br />209-946-0772 <br />Mailing Address <br />PO BOX 976 <br />N <br />HORSHAM, PA 19044 <br />Care of <br />Location Code 01 - STOCKTON <br />BOS District 001 - VILLAPUDUA <br />APN 16912003 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0007255 <br />Maillnvoicesto Facility <br />Account Name EARTHGRAINS BAKING CO INC <br />Account Balance as of 9/19/2013: $325.00 <br />Program/Element and Description <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />l�iA'3" • • <br />raj. "� • ����� <br />Site Mitigation Facility <br />Alt Phone <br />Fax <br />EMail <br />Record ID Employee ID and Name <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transferto ActivellnacNe <br />Status New Owner? Delete <br />1921 - HMBP-Regular-Primary Location <br />PRO519612 <br />EE0009817 - ROBERT LOPEZ <br />Inaetivf <br />Y <br />N <br />A I C <br />2220 - SM HW GEN <5 TONS/YR <br />PRO513821 <br />EE0001421 - STACY RIVERA <br />Inactive <br />Y <br />N <br />A I C <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION <br />PRO511699 <br />EE0000000 - HAZ MAT SJC DES <br />Inactive <br />Y <br />N <br />A I C <br />2381 - UST FACILITY (BEFORE 1/84) - obsolete <br />PR0504354 <br />EE0000008 - LETITIA BRIGGS <br />Inactive <br />Y <br />N <br />A I C <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F <br />PR0509411 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A I C <br />2840 -AST EXEMPT FAC < 1,320 GAL <br />PR0531049 <br />EE0001421 - STACY RIVERA <br />Inactive <br />Y <br />N <br />A I C <br />4740 - WASTE TIRE SITE - EXEMPT <br />PRO528634 <br />EE0002622 - BENJAMIN ESCOTTO <br />InactivE <br />Y <br />N <br />A I C <br />- ELECTRONIC REPORTING STATE SURCHARG <br />PRO532299 <br />Inactive <br />Y <br />N <br />A I C <br />'ERSC <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent <br />of same, acknowledge that all site, andor project specific, <br />PHS/EHD hourly chargee <br />associated with this facility <br />or activity will be billed to the party identified as the OWNER on this form l also certify that all operations <br />will be performed in accordance with all applicable <br />Ordinance Codes andor Standards <br />and State ardor <br />Federal Laws. <br />APPLICANT'S SIGNATURE: 5C-'t'C— ad ezt &IN•Gf I Date <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS: (Z U4 <br />C4 1 �s <br />$25.00 = <br />Date <br />I� <br />Amount Paid Date <br />Amount Paid Date <br />Receive y <br />Account out: Date 13 <br />