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Report#5021 <br /> Date run g/5/2012 2:09:44PM SAN JO. IN COUNTY ENVIRONMENTAL HEAL DEPARTMENT Pagell <br /> RW by Facility Information as of 9/5/2012 <br /> Record Selection Criteria: Facility ID FA0009479 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> owner ID OW0007479 Case Number: H04393 New owner ID <br /> Owner Name GRANITE CONSTRUCTION COMPANY <br /> owner DBA GRANITE CONST CO (TRACY SITE) <br /> Owner Address PO BOX 151 <br /> TRACY, CA 95201 <br /> Home Phone 209-982-4750 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 151 <br /> STOCKTON, CA 95201 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009479 <br /> Facility Name GRANITE CONST CO <br /> Location 30909 S TRACY BLVD <br /> TRACY, CA 95377 <br /> Phone 209-982-4750 <br /> Mailing Address PO BOX 151 <br /> STOCKTON, CA 95201 <br /> Care of <br /> Location code 99-UNINCORPORATED P Alt Phone <br /> Bos District 005-ORNELLAS, LEROY Fax <br /> APN 25310006 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION AA <br /> Contact Name r6 <br /> Title r4-1 <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016479 New Account ID: <br /> Mail lnvoicesto Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name GRANITE CONSTCO (Circle One) <br /> Account Balance as of 9/5/2012: $0.00 <br /> (Circle One) <br /> Transfer to Aclivellnaclve <br /> Progra"Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0519670 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 22 - M HW GEN<5 TONSNR PRO513862 EE0002646-THUY TRAN Active Y N A 0 D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOfPR0511767 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PR0509479 EE0000000-HAZ MAT SJC OES Inactive Y N A b D <br /> -2832'-AST FAC 10 K-</=100 K GAL CUMULATIVEPRO527979 EE0002646-THUY TRAN Active Y N A I D <br /> ERSC- ECTRONIC REPORTING STATE SURCHPR0533479 Active Y N A I D <br /> BILLING antl CO LIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge Oat al l site,anclor project specific, hourly charges assmated with this facility <br /> or activity will be bill o Oe party identified as the OWNER an this form I also certify that all operations will be performed to accordance with all applicable Ordinance Codes anaor Standards and Stale endo <br /> Federel Laws <br /> APPLICANTS SIGNATURE: - Date <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid D te_/ / <br /> Payment Type Check Number Receiv y <br /> REHS: Date ll Account out: Date I1,l�Z— <br /> COMMENTS: <br /> 11tM k* Yl# tnAd*4 - r l OF 1r0-l . <br />