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Date run 2/252013 4:50:20PR SAN J( )UIN COUNTY ENVIRONMENTAL HEe' `I DEPARTMENT Report#5021 <br /> Run by `/ Pagel <br /> Facility Information as of 2/25/2013 <br /> Record Selection Criteria: Facility lD FA0010986 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0012761 New Owner ID <br /> Owner Name OLDCASTLE PRECAST INC <br /> Owner DBA <br /> Owner Address PO BOX 608 DR <br /> AUBURN, WA 98071 <br /> Home Phone 253-833-2777 <br /> Work/BusinessPhone 209-858-0225-4660-' / <br /> Mailing Address PO BOX 608 /D <br /> AUBURN, WA 886Tt�319P I <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010986 <br /> Facility Name OLDCASTLE PRECAST <br /> Location 15540 S MCKINLEY RD <br /> LATHROP, CA 95330 <br /> Phone 209-858-0225 _ <br /> Mailing Address PO BOX 608 L( <br /> AUBURN, WA88074- <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 003-BESTOLARI DES Fax <br /> APN 19806010 EMail: <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 / Facility / Account <br /> Account Name OLDCASTLE PRECAST (Circle One) <br /> Account Balance as of 2/25/2013: $923.00 <br /> (circle one) <br /> Transfer to Aclivdlnactve <br /> ProgramfElement and Description Record ID Employee ID and Name Sletua 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 TONS/YR PR0528654 EE0002646-THUY TRAN Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0510986 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528653 EE0002646-THUY TRAN Active,Exempt Y N A 1 D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0533334 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOViLEDGEMENT: I,the undersigned owner,operator or agent of same acknowledge Net all age,and 1 0 apsa1c,PHSIEHD hourly charges associated with this reality <br /> or activitymwill be D'IINtl_ tp the itl i form 1 also uriM thatWent •til be etl in accord ZII applkeble Ortlinence Codea ardor Slentlerde and State ender <br /> Fedenl Lawa <br /> APPLICANTS 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 Rete y <br /> REHS: ^ Date_/_/ Aacunt t: <br /> COMMENTS: Q 5. II n <br />