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Dale run 6/11/2008 3:41:36PK SAn ' r _ <br /> Run t ���QUIN COUNTY.ENVIRONMENTAL� H DEPARTMENT- Reprnt+tsti2t <br /> E <br /> Facility Information as of 6/11/2008 Pagel <br /> h Record Sekction Criteria: Facility ID FA0009531 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE_(date) ... <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> Owner ID' OW0007531 New Owner ID <br /> Owner Name UNIVERSAL FOREST PRODUCTS <br /> Owner DBA" # - <br /> s Owner.Address 2801 Q E BELTLINE ST <br /> GRAND RAPIDS, MI 49525 <br /> HomejPhone 616-364-6161 <br /> Work/Susiness Phone Not Specified <br /> .Mailing Address 2801E BELTLINE ST <br /> GRAND RAPIDS, M1 .49525 <br /> Care of. UNIVERSAL FOREST-PRODUCTS . <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0009531 <br /> Facility Name UNIVERSAL FOREST PRODUCTS <br /> Location 26200 N NOWELL RD <br /> THORNTON, CA 95686 <br /> Phone 209-794-8750 <br /> Mailing Address 2801 E BELTLINE ST <br /> GRAND RAPIDS, MI 49525 <br /> Care of <br /> Location Code 99-'UNINCORPORATED A Alt Phone <br /> BOS District 004=VOGEL, KEN Fax <br /> APN 00123020 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 AR0016531 New Account IM <br /> Mail Invoices to Facility Mail Invoices to: Owner I Facility I Account <br /> Account Name UNIVERSAL FOREST PRODUCTS (CirdeOne) <br /> Account Balance as of 611112008: $0.00 <br /> (Circle One) <br /> Transfer to Active/Ina ive <br /> ProgramlEkment and Oesmption Record ID Emptoyee ID and Name Status New owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0513888 EE0001422-ARIS CACAPIT 'Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPR0511819. EE0060000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO519309 EE0000000-HAZ,MAT SJC OES Active Y. N A I D <br /> 2381 -UST FACILITY(BEFORE 1184)-obsolete PR0503803 EE0004636-GARRETT BACKUS Inactive Y N A I D <br /> 2399 a UNIFIED PROGRAM FAC STATE SURCHARPRO509531 -EE0000000-HAZ MAT SJC OES Y N $ I" D <br /> 3 -AST FAC>I=100 M+ 1 GAL CUMULATIVE PRO516199 EE0001422=ARIS CACAPIT ctive Y N %a) I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO527998 EE0001419--KRISTIAN LUCAS Clive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent,of same,acknowledge that all sit ,and/or project specific,PH;/EHD hourty'charges associated with this <br /> facility or activity vdll be billed to the party identified as the OWNER on ttds form. I also certify that all operations will bd performed' accordance withan applicabl Ordmace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT' SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: `$20.00= Amount Paid Date I I <br /> Water System to be TRANSFERED:. '$372.00= 'Amount Paid Date 1 1 <br /> Payment Type Check Number Rece' <br /> REHS: Date I 1 Account out: Date l <br /> COMMENTS: I <br /> llphs-ehsql-ntlappslenvisionslreports15021.rpt _ <br />