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Dale run 4/8/2013 4:22:15PM SAN JOnawJIN COUNTY ENVIRONMENTAL HEAL.-W DEPARTMENT Report 95021 <br /> Run I'f. Paget <br /> Facility Information as of 4/8/2013 <br /> Record selection Criteria: Facility 10 FA0005302 <br /> / Make changes/corrections In RED Ink. <br /> /\'� \ INFORMATION CHANGE(date) <br /> �J,�.��-0 OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION A n \ /��� SSN/Fed Tax ID <br /> Owner ID OW0003473 \" " '\�" New Owner ID <br /> Owner Name SPRECKELS SUGAR CO �hh3 <br /> Owner DBA SPRECKELS SUGAR COMPANY U <br /> Owner Address 20500 HOLLY DR <br /> TRACY, CA 953041649 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-835-3217 <br /> Mailing Address PO BOX 68 <br /> MENDOTA, CA 93640 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID I CERS ID FA0005302 10,181,793 <br /> Facility Name SPRECKELS SUGAR COMPANY <br /> Location 20500 HOLLY DR <br /> TRACY, CA 95304 <br /> Phone 209-835-3217 <br /> Mailing Address PO BOX 68 <br /> MENDOTA, CA 93640 <br /> Care of <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> SOS District 005-ORNELLAS, LEROY V % Fax <br /> APN 21216010 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION�� <br /> Contact Name ` I <br /> Title , <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005764 New Account ID: <br /> Mail Invoices to Facility � � Mail Invoices to: Owner / Facility / Account <br /> Account Name SPRECKELS SUGAR COMPANY (CimAeOne) <br /> Account Balance as of 4/8/2013: $608.00 <br /> / (Circle One) <br /> Transfer to ActNerinacNe <br /> PrograrnfElement and Description Record ID Employee ID and Name Status New Ovmer7 Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519583 EE0002474-MICHAEL PARISSI Active Y N A 1 ) D <br /> 2220-SM HW GEN<5 TONS/YR PRO513793 EE0002646-THUY TRAN Active Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0511655 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A I- D <br /> 2361 -UST FACILITY PR0502021 EE0002646-THUY TRAN Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PRO507590 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PROSI 5794 EE0002646-THUY TRAN Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPRO531511 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,Ne undersigned owner,operator or agent of same,sclmoMedge Nat ell site,sndor project specific.PHSIEHO hourly charges essodated with this facility <br /> or edNity,will ba billed to the party identified as Ne OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes ancior Standards and State and« <br /> Federal Lewy. <br /> APPLICANTS SIGNATURE: ler-'S�— J-1C{,✓G -'— Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paidto <br /> Payment Tye Check Number Recei b7y <br /> RENS: '�` Date-AX-11C. / Account out: _ Date 1 / <br /> COMMENTS: <br />