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Date ran 5/5/2010 11:17:53AM SAN J4--'QUIN COUNTY ENVIRONMENTAL HE/-":'H DEPARTMENT Report p5021Pagef <br /> Run by Facility Information as of 5/5/2b1'6 <br /> Record Selection Criteria'. Facility ID FAD009479 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) �v <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 AN Phone <br /> BOS District 005-ORNELLAS, LEROY Fax <br /> APN 25310006 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name_UR4At44 GiFFM{1{J MARIL T�StL <br /> Title R J, <br /> Day Phone 269982=475$— '\ �`. <br /> Night Phone QQ9.969-2926- <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016479 New Account to: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility I Account <br /> Account Name GRANITE CONST CO (c"`e One) <br /> Account Balance as of 5/5/2010: $0.00 <br /> (Circle One) <br /> Transferto Activeimactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner± Delete <br /> 2220-SM HW GEN<5 TONS/YR PRO513862 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511767 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO519670 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> -UNIFIED PROGRAM FAC STATE SURCHARPR0509479 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2833 AST FAC 100 K+1 -</=1 M GAL CUMULATPRO527979 EE0001421 -STACY RIVERA Active Y N A 1 D <br /> C-ELECTRONIC REPORTING SURCHARGE PR0533479 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator"agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the parry,identified as the OWNER on this form. I also certify that all operations we be performed in axordance with all applirade Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> w t ; ) ,f,cz+D Io, �) 12� 9a,Q st� ca pa.-ri I S . <br /> APPLICA S SIGNATURE: `/bW O�P/ ill azk 1/044^/(r( Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: _*$372.00= Amount Paid Date <br /> Payment Type Check Number Receiv <br /> REH Date C / 11� Account out: Date 4 <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />