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Date run 3;2012013 10:38:49AI ,SAN JOIN COUNTY.ENVIRONMENTAL HEA 6PARTMENT Raw#5021 <br /> Run by `^ <br /> Pagel <br /> Facility Information as of 3/20/2013 <br /> Record Selection Criteria: Facility ID FA0005525 <br /> Make changes/corrections in RED ink. I�Al, <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID <br /> Owner ID OW0004352 New Owner ID <br /> Owner Name A TEICHERT 8 SON <br /> Owner DBA TEICHERT AGGREGATES (MACARTHUR <br /> Owner Address PO BOX 247 <br /> TRACY, CA 95376 <br /> Home Phone Not Specified <br /> Work/Business Phone 916484-3011 <br /> Mailing Address PO BOX 15002 <br /> SACRAMENTO, CA 95851 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0005525 10,181,849 <br /> Facility Name TEICHERT-TRACY ROCK PLANT <br /> Location 29099 S MACARTHUR DR <br /> TRACY, CA 95377 <br /> Phone 209-832-4150 <br /> Mailing Address PO BOX 15002 <br /> SACRAMENTO, CA 95851 <br /> Care of <br /> Location Cade 99 - UNINCORPORATED p Alt Phone <br /> BOS District 005 -ORNELLAS, LEROY Fax <br /> APN 25312012 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ` <br /> Title tiff`' <br /> vf` <br /> Day Phone ISE` <br /> S � <br /> Night Phone //,^ y + <br /> ACCOUNTS RECEIVABLE FILE INFORMATION r' <br /> ',0 <br /> AR0006106 1- .� <br /> Account ID do' � New Account ID: <br /> Mail Invoices to Facility ud - Mail Invoices to: Owner / Facility 1 Account <br /> Account Name TEICH ERT-T CY ROCK PLANT '` I A I`� (Circle Ona) <br /> Account Balance as of 3/20/2013: $>7 .00 <br /> (Circle One) <br /> Transfer to Active/lnactve <br /> ProgramfElement end Description Record ID Employee ID and Name Status New Owner? Deieta <br /> T_MBP-Reqular.Primary Location PR0519559�EE0002474�M1__CHAEVPARISSIJW-,Activate Y N AI• D <br /> e2220-5m HW GEN<5 TONSIYR PR0513778 EE0002646-THUY TRAN --Aetwee— Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOtPR0511626 EEO000000-HAZ MAT SJC OES Inactive Y N A I D <br /> �33�---EXEMPT TANK FACILITY PRO502654 EE0000451 -STEVE SASSON Aelive Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PRO509338 EEOO00000-HAZ MAT SJC IDES Inactive Y N A 0 <br /> ,2834--,4ST FAC >/= 1,320-<10 K GAL CUMULATNPR0535258 EE0002646-THUY TRAN ftctive{yfempi_ Y N A 0 <br /> 4740-WASTE TIRE SITE-EXEMPT PRO523700 EE0004045-TED TASIOPOULOS Active Y N A 0 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHrPRO533958 Inactive 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 projed specific.PHSIEHD 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 applicable Ordinance Codes ancilor Standards and Slate ardor <br /> Federal Laws � Ll I lo <br /> APPLICANT'S SIGNATURE: 1 Date 1 I <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERFD: Amount Paid Date 1 1 <br /> Payment Type Check Number Recei d 3 <br /> REHS: ate��p, 1 / QA�ccounnttoou�t: [ Dfatte/f[ 1f}Q�CJ�f%J1 f � • �p� <br /> COMMENTS: {>jy1 { <br />