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Date run --74- -,-2 ',' <br /> Run b 013 4:50:20PA SAN Jl"'- �! <br /> 2UIN COUNTY ENVIRONMENTAL HE/ H DEPARTMENT Report 1115021 <br /> , <br /> Facility Information as of 2/25/2013 Pagel <br /> R-cord Selection Criteria: Facility I FA0010986 <br /> Make changesicorrections In RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner to OW0012761 New Owner ID <br /> Owner Name OLDCASTLE PRECAST INC <br /> Owner DBA <br /> Owner Address PO BOX 608 DR �vZ <br /> AUBURN, WA 98071 <br /> Home Phone 253-833-2777 <br /> Work/Business Phone 209-858-0225 <br /> Mailing Address -F-G-BOX"o <br /> AiJBt7RN;W4 9071 "J U d Careofof <br /> FACILITY FILE INFORMATION <br /> FacilityiD FA0010986 �I <br /> Facility Name OLDCASTLE PRECAST <br /> Location 15540 S MCKINLEY RD <br /> LATHROP, CA 95330 <br /> Phone 209-858-0225 <br /> Mailing Address <br /> et la,� LWN. W oonzt f <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 003- BESTOLARIDES Fax <br /> APN 19806010 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ERNEST JORDAN <br /> Title PLANT MANAGER <br /> Day Phone 209-858-0225 <br /> Night Phone 209-495-0796 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017986 New Account ID <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facili ) Account <br /> Account Name OLDCASTLE PRECAST (c cIs0 <br /> Account Balance as of 2/25/2013: $923.00 <br /> (Circle One) <br /> Program/Element and Description to Aegvennadve <br /> lion Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO513274 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO528654 EE0002646-THUY TRAN Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0510986 EE0000000-HAZ MAT Sic OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0528653 EE0002646-THUY TRAN Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0533334 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,the undersigned owner,operator or agent of same acknowledge that all site,andor project specific,PHS/EHD hourly charges assocleted with this facility <br /> or activity will be billed to the party identified as the OWNER an this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andfor Standards and State and' <br /> Federal Laws. <br /> APPLICA SSI NATURE: Date _/ / I , �LJ$YQI <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date_/_/_ice—, <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Recely L/ <br /> REHS: Date_/_/ Account t: Date / / <br /> COMMENTS: <br />