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. i <br /> f s Report#5021' <br /> Dien` 125/2013 4:50:20PIi SAN J( TJiN COUNTY ENVIRONNMNTAL HEAh DEPARTMENT <br /> Pagel' <br /> R by Facility Information as of 2125/2013 ` <br /> M <br /> RAcord Selection Criteria: Facility ID FA0010986 <br /> Make changeslcorrectlons in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN I Fed Tax ID > <br /> Owner ID OW0012761 New Owner,ID <br /> owner Name OLDCASTLE PRECAST INC <br /> Owner DBA <br /> Owner Address PO BOX 608 DR <br /> AUBURN, WA 98071 <br /> Home Phone 253-833-2777 <br /> Work/Business Phone .249-858-0225 . !� ` <br /> Mailing Address 0 S, L l <br /> 9 071 & <br /> Care of 2 �� <br /> k FACILITY FILE INFORMATION <br /> F Facility 1D -FA0010986 <br /> E Facility Name OLDCASTLE PRECAST <br /> Location 45540 S MCKINLEY RD [,�AIvr- <br /> 1 LATHROP, CA 95330 <br /> Phone 209-858-0225 .. . <br /> Mailing Addres `�vom,r5h{P, <br /> I K Al.liQ�t ►n� aa .,� V - -- <br /> 1 Care of <br /> Location Code Alt Phone - <br /> r BIDS District 003-SESTOLARIDES Fax <br /> APN 19806010 EMaEI: <br /> I EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> I <br /> I 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 /> i <br /> i Account ID AR0017986 New Account I <br /> D- <br /> Mall Invoices to Facility Mail Invoices to: Ownerccount <br /> AccountName OLDCASTLE PRECAST <br /> Account Balance as of 2/25/2013: $923.00 <br /> {i (Circle One) <br /> Transfer to Activennactve <br /> Program/Element and Description Record ID Employee.rD and Name. Status New Owner Delete <br /> { 1921 -HMBP-Regular-Primary Location PRO513274 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0528654 EE0002646=THUY TRAN Active Y N A' I D <br /> I 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0510986 E=E0000000-HAZ MAT SJC-OES Inactive Y N A I D <br /> C2840-AST EXEMPT-FAC 11<320 GAL PR0528653 EE0002646-THUY TRAN Active,Exempt Y N �A I D <br /> ERSC-:ELECTRONIC REPORTING STATE SURCHPR05333344 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: f,the undersigned owner,operator or agent of same,acknowledge that all site,andror project specific,PHSIEHD hourly charges associated with this facility <br /> I or activity will be billed to the party idenlified as the OWNER on this fomt I also certify that all operations will be performed In accordance with all applicable Ordinance Codes andlor Standards and Stale andl�� <br /> Federal Laws. <br /> I <br /> Da <br /> APPLICA S Sl NATURE: <br /> Date 1 I tIGo� 1" a� <br /> Program Records to be TRANSFERED: *$25.00= Amount Paid. Date 1 I <br /> Water System fo be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Racely <br /> RENS: rJ} Date 1 I Account t: Date .1 1 <br /> 'I COMMENTS: <br />