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Dalgrun �W19/2013 11:00:03AI SAN JQ`^UIN COUNTY ENVIRONMENTAL HEA `siil DEPARTMENT Report 05021pagal <br /> Rur by <br /> Facility Information as of 9/19/2013 <br /> Record Selection Criteria: Facility ID FA0006174 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax 10 <br /> Owner ID OW0004923 New Owner ID <br /> Owner Name EARTH GRAINS BAKING COMPANIES INC <br /> Owner DBA EARTHGRAINS BAKING CO INC THE <br /> Owner Address S PO BOX 976 WAY <br /> HORSHAM, PA 19044 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 976 IVo dk , 91J/OZ <br /> HORSHAM, PA 19044 L O �_ O <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID I CERS ID FA0006174 10,182,041 <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 PO BOX 976 464 7610),7 _ <br /> HORSHAM, PA 19044 )C- Wall 7rl 71,16 <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 ID AR0007255 New Account ID: <br /> Maillnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name EARTHGRAINS BAKING CO INC (Circle One) <br /> Account Balance as of 9/19/2013: $325.00 <br /> (Circle One) <br /> Transfer to Activelnaclve <br /> PrograwElemenl and Description Record ID Employee ID and Name Status New Omer? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519612 EE0009817-ROBERT LOPEZ Inactive Y N A I D <br /> 2220-SM HW GEN <5 TONS/YR PRO513821 EE0001421 -STACY RIVERA Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511699 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0504354 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509411 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PR0531049 EE0001421 -STACY RIVERA Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0528634 EE0002622-BENJAMIN ESCOTTO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0532299 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 pro)ect spec,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER an this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes angor Standards and State andor <br /> Federal Laws <br /> APPLICANTS SIGNATURE: �-- !'l " Al' 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 Receivedby '�7 <br /> ZL <br /> REHS: Date / / Account out: Date�/ / 1 <br /> COMMENTS: 7 I/ n I ^ I q <br />