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Rateun run 615/2014 9:01-58AM SAN SIC UIN COUNTY ENVIRONMENTAL HEA,�`i DEPARTMENT Report#5021 <br /> Facility Information as of 6/5/2014 Page, <br /> Record Selection Criteria: Facility ID FA00194 71 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of faciiities for this owner. 1 SSN/Fed Tax ID <br /> Owner ID OW0015959 New Owner ID : <br /> Owner Name SHIMMICK CONSTRUCTION CO INC <br /> Owner DBA SHIMMICK CONSTRUCTION CO INC <br /> Owner Address 23623 S BIRD RD <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> Work/Business Phone - 00 <br /> Mailing Address 23623 S BIRD RD <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0019471 10187255 <br /> Facility Name SHIMMICK CONSTRUCTION CO INC <br /> Location 23623 S BIRD RD <br /> TRACY, CA 95304 <br /> Phone 209-830-6500 x0 <br /> Mailing Address 23623 S BIRD RD <br /> TRACY, CA 95304 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> SOS District 005 - ELLIOTT, BOB Fax <br /> APN 25010003 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION �S <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account iD AR0034621 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner 1 Facility f Account <br /> Account Name SHIMMICK CONSTRUCTION CO .INC (Circle One) <br /> Account Balance as of 61512014: $0.00 <br /> (Circle ane) <br /> Transfer to Activeflnactive <br /> -11ragramlElement and Description Record 1D Employee ID and Name Status New Owner? Delete <br /> �-11921 -HMBP-Reqular-Primary Locat PRO529204 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> fiHW GEN <5 TONS/YR ,Z� PRO538561 EE0002646 THUY TRAN Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATES RCHARG PRO532820 Inactivf 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,.PHSJEH❑hourly charges associated with this facility or <br /> 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 andtor Standards and State andor Federal Laws. <br /> APPLICANT'S SIGNATURE Date / <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date ! / <br /> Payment Type Check Number Receb by <br /> REHS. ((} Date 0 11 ! Account out1 r- f /+A� r� (�DatayryG <br /> COMMENTS: <br /> l.� d--�O� W'`�'Q�`1 <br />