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f <br />Datraa 12/5/2017 4:53:25PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 12/5/2017 <br />Record Selection Criteria: Facility ID FA0009760 <br />OWNER FILE INFORMATION Number of facilities for this owner: 1 <br />Owner ID OW0007760 Case Number: H05347 <br />Owner Name <br />DIAMOND FOODS LLC <br />Owner DBA <br />DIAMOND FOODS INC <br />Owner Address <br />19525 E MAIN ST <br />LINDEN, CA 95236 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-467-6000 <br />Mailing Address <br />PO BOX 1727 <br />A D <br />STOCKTON, CA 95201-1727 <br />Care of <br />N <br />FACILITY FILE INFORMATION <br />Facility ID / CERS ID FA0009760 10182881 <br />Facility Name DIAMOND FOODS LLC <br />Location 19525 E MAIN ST <br />LINDEN, CA 95236 <br />Phone 209-887-3565 x0 <br />Mailing Address PO BOX 1727 <br />STOCKTON, CA 95201-1727 <br />Care of Diamond Foods LLC <br />Location Code 99 - UNINCORPORATED P <br />BOS District 004 - WINN, CHARLES <br />APN 09129009 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0016760 t <br />Mail Invoices to Account <br />Account Name DIAMOND F DS LL <br />Account Balance as of 12/5/2017:/ $4 .00 <br />Program/Element and Description / Record ID <br />1921 - HMBP-Reqular-Primary Location//! PR051985� <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATION PR051204E <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARGE F PR050976( <br />ERSC - ELECTRONIC REPORTING STATE SURCHARG PR053457E <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN/Fed Tax ID <br />New Owner ID : <br />Employee ID and Name <br />New Account ID: <br />Mail Invoices to: Owner / <br />EE0008709 - JAMIE LIMA <br />EE0000000 - HAZ MAT SJC OES <br />EE0000000 - HAZ MAT SJC OES <br />Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Status <br />New Owner? <br />Delete <br />Active <br />Y <br />N <br />AI D <br />Inactive <br />Y <br />N <br />A D <br />Inactive <br />Y <br />N <br />A I D <br />Inactive <br />Y <br />N <br />A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, andlor 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 applicable Ordinance Codes and/or Standards and State and/or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Date <br />Program Records to be TRANSFERED: $25.00 = Amount Paid Date <br />Water System to be TRANSFERED: Amount Paid Date <br />Payment Ty e Check Number Received by /-)-Y / f <br />EHD Staff: � ��Q� Date _�/ 162 Account out: _ � Date <br />COMMENTS: <br />L� n _ Invoice #: <br />QT� T' <br />