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Date= 1/15/2013 11:59:50AI SANK UIN COUNTY ENVIRONMENTAL HEA' I DEPARTMENT Report*5021 <br /> Run by ANO, 14mot <br /> Facility Information as of 1/15/2013Pagel <br /> Record Selection Criteria: Facilrry ID FA0021035 <br /> Make changestcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0017313 New Owner ID <br /> Owner Name OCC/GLENN SPRINGS HOLDINGS I <br /> Owner DBA OCCIDENTAL CHEMICAL CORP <br /> Owner Address r--CrO L 3 J Fk-z-C=w n-Y <br /> SAN FRANGISGO, CA 94104Sutc (340 <br /> Home Phone Not Specified T <br /> Work/Business Phone 972_687-7509 <br /> Mailing Address 630 PLAZA DR STE#600 <br /> HIGHLANDS RANCH, CO 80129 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0021035 <br /> Facility Name OCCIDENTAL CHEMICAL CORP <br /> Location 16777 HOWLAND RD <br /> LATHROP, CA 95330 <br /> Phone 209-858-4533 x0 <br /> Mailing Address 100 MONTGOMERY ST Sb os- L,p^.T �Ir-� +.✓RY 5'cri rerL3TD <br /> SAN FRANCISCO, CA 94104 Tx 75-Z ql( <br /> Care of <br /> Location Code 07 - LATHROP Alt Phone <br /> Bos District 003- BESTOLARIDES Fax <br /> APN 19818005 EMail: <br /> `W-WRGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0037854 New Account ID: <br /> Mail Invoices to Account Mail tnvoices to: Owner / Facility / Account <br /> Account Name OCCIDENTAL CHEMICAL CORP (Circle One) <br /> Account Balance as of 1/15/2013: $0.00 <br /> (Circle One) <br /> Transfer to Activoinactve <br /> P renVElement and Description Record ID Employee ID and Name Status New Gwner9 Delete <br /> '192y-HMBP-Regular-Primary Location PR0536627 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> SC-ELECTRONIC REPORTING STATE SURCH,PRO536839 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT'. I,the undersigned owner,operator or agent of same,acknowledge that all site,ender project specific,PHS/EHD hourly charges associated with this facthy <br /> or activity will be billed to the party identified as the OWNER on this forth I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and Slate ander <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date I / <br /> Payment Type �— -.�- Check Number Receiv b <br /> RENS: "T '- Date Account out: Date ll <br /> ^RENTS. <br />