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Date con 2!18/2014 10:01:11AI SAN JOE�TIN COUNTY ENVIRONMENTAL HEAL�DEPARTMENT Rcpod#5021 <br /> Run by 1273 Pagel <br /> Facility Information as of 2/18/2014 <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 100215TH ST <br /> AUBURN, WA 98001 <br /> Home Phone 253-833-2777 <br /> Work/Business Phone 209-858-0225 <br /> Mailing Address 15540 S MCKINLEY RD -2g 7 <br /> LATHROP, CA 95330 kil � <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/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 15540 S MCKINLEY RD 7 X V7 _ <br /> LATHROP, CA 95330 tsLE It <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 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 2/18/2014: $923.00 <br /> (Circle One) <br /> Transfer to Active/InacNe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owne? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0513274 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO528654 EE0002646-THUY TRAIN Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510986 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PR0528653 EE0002646-THUY TRAN Active,! Y N A I D <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,andor project specific.PHStEHD hourly charges associated with this facility <br /> or activity will be biked 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 angor Standards and State angor <br /> Federal Laws. <br /> APPLICANT'S 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 Check Number Receiv y <br /> REHS: Date_/ / Account out: Date—A—/ /L <br /> COMMENTS: <br />