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Date run 12/18/2002 12:35:051 SAN JOA 'TIN COUNTY ENVIRONMENTAL HEAL'ryl DEPARTMENT Report#5021 <br />Run by Pagel <br />Facility Information as of 12/18/26.._ <br />Record Selection Criteria: Facility ID FA0005302 <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0003473 <br />Owner Name <br />SPRECKELS SUGAR CO <br />Owner DBA <br />SPRECKELS SUGAR CO <br />Owner Address <br />PO BOX 60 <br />Active <br />TRACY, CA 95378 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />Not Specified <br />Mailing Address PO BOX 60 <br />TRACY, CA 95378 <br />Care of HOLLY SUGAR CORP <br />FACILITY FILE INFORMATION <br />Facility ID FA0005302 <br />Facility Name HOLLY SUGAR CORP <br />Location 20500 HOLLY DR <br />TRACY, CA 95376 <br />Phone <br />Mailing Address PO BOX 60 <br />TRACY, CA 95376 <br />Care of HOLLY SUGAR CORP <br />Location Code 03 -TRACY <br />BOS District 005 - ORNELLAS, LEROY <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0005764 <br />Mail Invoices to Facility <br />Account Name HOLLY SUGAR CORP <br />Account Balance as of 12/18/2002: $0.00 <br />Program/Element and Description <br />Record ID Employee ID and Name <br />Make changes/corrections in RED ink or pencil. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />New Owner ID <br />_T APN: <br />SIC Code: <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />(Circle One) <br />Transfer to Active/Inactve <br />Status New Owner? Delete <br />2220 - SM HW GEN <5 TONS/YR PR0513793 <br />EE0000451 - STEVE SASSON <br />Active <br />Y <br />N <br />A I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511655 <br />EE0000000 - HAZ MAT SJC OES <br />Active <br />Y <br />N <br />A I D <br />2381 - UST FACILITY (BEFORE 1/84) PRO502021 <br />EE0000451 - STEVE SASSON <br />Active,Exempt <br />Y <br />N <br />A I D <br />2390 - ABOVEGROUND TANK (SPCC) PR0515794 <br />EE0000451 - STEVE SASSON <br />Active <br />Y <br />N <br />A I D <br />2399 - UNIFIED PROGRAM FAC STATE SERVICE FPR0507590 <br />EE0000451 - STEVE SASSON <br />Active <br />Y <br />N <br />A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or <br />project specific, PHS/EHD <br />hourly charges <br />associated with this <br />facility or activity will be billed to the party identified as the OWNER on this form. I also <br />certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br />State and/or Federal Laws. <br />APPLICANT'S SIGNATURE: <br />Program Records to be TRANSFERED: <br />Water System to be TRANSFERED: <br />Payment Type Check Number <br />REHS: <br />COMMENTS: <br />\\Phs-ehsq I-nt\apps\Envisions\Reports\5021. rpt <br />" $20.00 = <br />$155.00 = <br />Date <br />Date <br />Amount Paid Date <br />Amount Paid Date <br />Received bx <br />Account out: 7 Date <br />