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Date run 6/16/2014 11:50:29AI SAN JO&JIN COUNTY ENVIRONMENTAL HEAL.DEPARTMENT Report#5021 <br /> Run y + '. Pagel <br /> Facility Information as of 6/16/2014 <br /> Record Selection Criteria: Facility ID FA0019471 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0015959 New Owner ID <br /> Owner Name SHIMMICK CONSTRUCTION CO INC <br /> Owner DBA SHIMMICK CONSTRUCTION CO INC <br /> Owner Address 23623 S BIRD RD <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> Work/Business Phone 510-777-5000 <br /> Mailing Address 23623 S BIRD RD <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0019471 10187255 <br /> Facility Name SHIMMICK CONSTRUCTION CO INC <br /> Location 23623 S BIRD RD <br /> TRACY, CA 95304 <br /> Phone 209-830-6500 x0 <br /> Mailing Address 23623 S BIRD RD <br /> TRACY, CA 95304 <br /> Care of <br /> Location Code 99- UNINCORPORATED P It Phone <br /> BOS District 005 - ELLIOTT, BOB Fax <br /> APN 25010003 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 AR0034621 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name SHIMMICK CONSTRUCTION CO INC (Circle One) <br /> Account Balance as of 6/16/2014: $0.00 <br /> (Circle One) <br /> Transfer to ActiveAnactve <br /> PrograMElemenl and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0529204 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PRO538561 EE0002646-THUY TRAN Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO632820 Inactivt Y N A I D <br /> BILLING and COMPLIANCE ACI(NOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge Nat all site,andor project specific,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on thisform. l also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and Stale andor <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 Reoewl)bin <br /> REHS: Date / / Account out: Date <br /> COMMENTS: fnJ �6a CO <br />