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Date run $15/2014 10:53:17AM SAN J. IIN COUNTY ENVIRONMENTAL HEA DEPARTMENT Report#5021 <br /> RiS^<by Pagel <br /> Facility Information as of 6/5/2014 <br /> Record Selection Criteria: Facility ID FA0009092 <br /> Make changes/corrections in RED ink. r <br /> INFORMATION CHANGE(date) J <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 2 SSNI Fed Tax ID <br /> Owner ID OW0007092 New Owner ID <br /> Owner Name ECKERT COLD STORAGE <br /> Owner DBA ECKERT COLD STORAGE (ESCALON) <br /> Owner Address 905 CLOUGH RD <br /> ESCALON, CA 95320 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-838-4040 <br /> Mailing Address 905 CLOUGH RD r <br /> ESCALON, CA 95320 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009092 10182409 <br /> Facility Name ECKERT COLD STORAGE <br /> Location 757 S MOFFAT BLVD <br /> MANTECA, CA 95336 <br /> Phone 209-823-3181 <br /> Mailing Address 905 CLOUGH RD <br /> ESCALON, CA 95320 <br /> Care of <br /> Location Code 04- MANTECA Alt Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 22104026 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 AR0016092 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ECKERT COLD STORAGE (Circle One) <br /> Account Balance as of 6/5/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0519376 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 1963-CaIARP PROGRAM 3 FACILITY PR0535177 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 1995-CalARP FAC STATE SURCHARGE FEE PR0519218 EEo000000-HAZ MAT SJC IDES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513633 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0511380 EE0000000-HAZ MAT SJC IDES InactivE Y N A I D <br /> 2226-CalARP PROGRAM PR0514524 EE0000000-HAZ MAT SJC OES InactivE Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0509092 EE00o0000-HAZ MAT SJC IDES InactivE Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0535073 EE0009000-HARPRIT MATTU Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531401 InactivE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andror project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance withal[applicable Ordinance Codes andror Standards and State and/or <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 <br /> REHS: _�(j +��� Date 4P / Account out: c Date <br /> COMMENTS: <br />