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Report 95021 <br /> r vn 10/9/2014 11:15:14AI SAN J UIN COUNTY ENVIRONMENTAL HEA0 DEPARTMENT Pagel <br /> °y R 1273 a ' Facility Information as of 10/9/2014 <br /> Record Selection cnlena: Facility ID FA0010273 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSNI Fed Tax ID <br /> Owner ID OW0008273 New Owner ID <br /> Owner Name COSTCO WHOLESALE CORP <br /> Owner DBA COSTCO WHOLESALE-MEATS#210 <br /> Owner Address 999 LAKE DR <br /> ISSAQUAH, WA 98027 <br /> Home Phone Not Specified <br /> Work/Business Phone 425-313-8100 <br /> Mailing Address PO BOX 35005 <br /> SEATTLE, WA 981243405 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010273 10146189 <br /> Facility Name COSTCO WHOLESALE- MEATS#210 <br /> Location 17880 W SCHULTE RD <br /> TRACY, CA 95376 <br /> Phone 209-833-9124 <br /> Mailing Address PO BOX 35005 <br /> SEATTLE, WA 981243405 <br /> Care of LICENSING <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 20911051 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> New Account ID: <br /> Account ID AR0017273 <br /> Mail Invoices to: Owner / Facility / Account <br /> Mail Invoices to Facility <br /> (Circle one) <br /> Account Name COSTCO WHOLESALE- MEATS#210 <br /> Account Balance as of 10/9/2014: $0.00 (Cirde One) <br /> Transferto AcWallnactve <br /> Program/Element and Description <br /> Record ID Employee ID and Name stews New Owner! Delete <br /> 1921 -HMBP-Regular-Primary Location PR0512561 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 1921 -HMBP-Regular-Primary Location PR0520193 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 1963-CaIARP PROGRAM 3 FACILITY PRO527108 EE0008317-RAYMOND VON FLUE Active Y N A 1 D <br /> 1995-CaIARP FAC STATE SURCHARGE FEE PR0518946 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO514265 EE0005642-MICHELLE HENRY Active Y N A I D <br /> 2226-CaIARP PROGRAM PR0514755 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2332-EXEMPT TANK FACILITY PRO524020 EE0002646-THUY TRAN Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO510273 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PRO536367 EE0005642-MICHELLE HENRY coveInactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0534373 <br />