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E <br /> 11/30/2015 10:51:29/ SAN JOIN COUNTY ENVIRONMENTAL HEM DEPARTMENT Report#5021 <br /> Pagel <br /> Facility Information as of 11/3012015on Criteria: Facility ID FA0010313 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0008313 Case Number: H07709 New Owner ID <br /> Owner Name SCHWAN'S HOME SERVICE INC <br /> Owner DBA SCHWAN'S HOME SERVICE INC <br /> Owner Address 115 W COLLEGE DR <br /> MARSHALL, MN 562581796 <br /> Home Phone Not Specified <br /> Work/Business Phone 507-537-8322 <br /> Mailing Address 115 WEST COLLEGE DRIVE <br /> Marshall, MN 56258 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0010313 10155367 <br /> Facility Name Schwan's Home Service Inc- Manteca, CA <br /> Location 575 INDUSTRIAL PARK DR <br /> Manteca, CA 95337 <br /> Phone 209-824-3011 x <br /> Mailing Address 115 WEST COLLEGE DRIVE <br /> Marshall, MN 56258 <br /> care of SCHWAN'S HOME SERVICE INC <br /> Location Code 04-MANTECA Alt Phone <br /> BOIS District 005-ELLIOTT, BOB Fax <br /> APN 22119058 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017313 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name Randy Sharbono (circle one) <br /> Account Balance as of 11/30/2015: $0.00 (Circle One) <br /> Transfer to Active'Inacive <br /> ProgramlElement and Description <br /> Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PRO520306 EE0000010-PETER LOMBARDI Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512601 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510313 EE0000000-HAZ MAT SJC IDES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO535380 EE0002622-BENJAMIN ESCOTTO Active <br /> Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532885 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHS'EHD hourly charges associated with this facility <br /> or activity will 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 applicabis Ordinance Codes andor Standards and State ands <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 <br /> Payment Type Check Number Received by <br /> EHD Staff: Date_/_/_ Account out: Date <br /> COMMENTS: Invoice#: <br />