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Date nm 12/24/2012 1128;24/ SAN IIN COUNTY ENVIRONMENTAL HEAI DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 12/24/2012 Pagel <br /> Record Selection Catena: Facility ID FA0006174 <br /> Make changes/corrections in RED ink. <br /> 2 INFORMATION CHANGE(date) 12 f IZ <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0004923 New Owner ID <br /> Owner Name EARTH GRAINS BAKING CO. <br /> Owner DBA EARTHGRAINS BAKING CO INC THE <br /> Owner Address 2651 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 2651 S AIRPORT WAY <br /> STOCKTON, CA 952063599 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0006174 <br /> Facility Name EARTHGRAINS BAKING CO INC <br /> Location 2651 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-946-0772 <br /> Mailing Address 2651 S AIRPORT WAY <br /> STOCKTON, CA 952063599 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 16912003 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account 10 AR0007255 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name EARTHGRAINS BAKING CO INC (Circle One) <br /> Account Balance as of 12/24/2012: $0.00 <br /> (Circle one) <br /> Transfer to Activellnactve <br /> PmgrarvElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519612 EE0009817-ROBERT LOPEZ Active Y N A D <br /> 2220-SM HW GEN<5 TONS/YR PR0513821 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOPPRO511699 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PRO504354 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PRO509411 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO531049 EE0001421 -STACY RIVERA Active,Exempt Y N A 6> D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO528634 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPR0532299 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andvor project specific,PHS/EHD hourly charges associated with this facility <br /> or adMy will be billed to the party identified as the OWNER on this farm I also certify that all operations will be performed in accordance with all applicable Ordinance Codes anNor Standards and State andlor <br /> Federal laws. Z V I I l8 1 IL t y <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 t c Number Rece e <br /> REHS: - Date Zzaj E/Z—?—Account out: Date / l� <br /> COMMENTS: <br />