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11 <br /> Date run 3/3&b14 1Q:29:28AM SAN JOIN COUNTY ENVIRONMENTAL HEAL`,,, Report#5021 <br /> DEPARTMENT Paget <br /> Run q <br /> Facility Information as of 3/3/2014 <br /> Record Selection Criteria: Facility ID 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 1002 15TH ST <br /> AUBURN, WA 98001 <br /> Home Phone 253-833-2777 <br /> Work/Business Phone 209-858-0225 <br /> Mailing Address PO BOX 727 <br /> PLEASANTON. CA 94566 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID I CERS ID FA0010986 10,184,013 <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 727 <br /> PLEASANTON, CA 94566 <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 003 - BESTOLARIDES 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 209495-0796 <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 (ciruaOne) <br /> Account Balance as of 3/3/2014: $923.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> Program/Element and Description Record ID Employee 10 and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0513274 EE0002474-MICHAEL PARISSI Active Y N AI D <br /> 2220-SM HW GEN<5 TONS/YR PR0528654 EE0002646-THUY TRAN Active Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510986 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0528653 EE0002646-THUY TRAINActive,l Y N A 0 <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533334 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 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 andor Standards and State ander <br /> Federal Lem <br /> APPLICANTS 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 <br /> 6LcK y Date Check Number / I Account out: Re ived b <br /> REHS: Date <br /> COMMENTS: {,' "at O S�� <br /> 19-2—( 4 <br /> 99a ( 4 Zz u, V fat-r-1 <br /> a--& 1 (o—3I—/,3-. N w raa.I--K f — ,Loa F'_ 3 <br />