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Repon ttouz 1 Date run 2/10/2016 4:33:26PR SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Pagel Run by Facility Information as of 2/10/2016 Record Selection Criteria: Facility ID FA0009519 Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) OWNER FILE INFORMATION Number of facilities for this owner: 1 Owner ID OW0007519 Case Number: H04697 Owner Name, jA0RI1/1E—L—F00DS-GORP Owner DBA Owner Address 1 S HORMET PL AUSTIN, MN 55912 Home Phone 507-437-5955 Work/Business Phone 507-437-5611 Mailing Address AUSTIN, MN 55912 Care of HORMEL FOODS CORPORATION FACILITY FILE INFORMATION SSN / Fed Tax ID New Owne, ID 75 s �1 Facility ID / CERS ID FA0009519 10182749 Facility Name Location 1404 S FRESNO AVE o STOCKTON, CA 95206 Phone 209-943-5411 X� Mailing Address PO BOX 100 STOCKTON, CA 95201 Care of Ken Feldman Location Code 01-STOCKTON BOS District 001 - VILLAPUDUA, CARLOS APN 16337018 EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0016519 Mail Invoices to Account Account Name HORMEL FOODS CORP Account Balance as of 2/10/2016: $518.00 Program/Element and Description ---------------------------- SS Alt Phone Fax EMail: n� •�� Gl7YttiZl i��''1 Record ID Employee ID and Name 1921 - HMBP-Regular-Primary Location PRO519695 I2220 - SM HW GEN <5 TONS/YR PR0513881 2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511807 2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509519 2840 - AST EXEMPT FAC < 1,320 GAL PRO516366 RG PR0531606 New Ac ount ID: Mail Invoices to: Owner / acility / Circle One) EE0009817 - ROBERT LOPEZ EE0001421 -STACY RIVERA EE0000000 - HAZ MAT SJC OES EE0000000 - HAZ MAT SJC OES EE0001421 - STACY RIVERA Account ERSC-ELECTRONIC REPORTING STA TEour'-, p'EHDhourlychargesassociatedwiththisfacility BILLING and COMPLIANCE ACKt or activity will be billed to the party Federal Laws. APPLICANT'S SIGNA owner, operator or agent of same, acknowledge that all site, and/or project specific, I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or Advl'g'-f— Date / / Date Program Records to b FERED: T_ " $25.00 = Amount Paid Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received by Date /��/ ACco t out:EHD Date COM Staff: — COMMENTS: A—J—� InVOICe #: (Circle One) Transfer to Active/Inactve Status New Owner? Delete Active Y N A I D Active Y N A I D Inactive Y N A I D Inactive Y N A I D Inactive Y N A I D Inactive Y N A I D ERSC-ELECTRONIC REPORTING STA TEour'-, p'EHDhourlychargesassociatedwiththisfacility BILLING and COMPLIANCE ACKt or activity will be billed to the party Federal Laws. APPLICANT'S SIGNA owner, operator or agent of same, acknowledge that all site, and/or project specific, I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or Advl'g'-f— Date / / Date Program Records to b FERED: T_ " $25.00 = Amount Paid Water System to be TRANSFERED: Amount Paid Date Payment Type Check Number Received by Date /��/ ACco t out:EHD Date COM Staff: — COMMENTS: A—J—� InVOICe #: