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Date run 3i20/2013 10:38:49AI SAN K JIN COUNTY ENVIRONMENTAL HEA1 DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 3/20/2013 <br /> Record Selection Criteria: Facility ID FA0005525 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0004352 New Owner ID <br /> Owner Name A TEICHERT& SON <br /> Owner DBA TEICHERT AGGREGATES (MACARTHUR <br /> Owner Address PO BOX 247 <br /> TRACY, CA 95376 <br /> Home Phone Not Specified <br /> Work/Business Phone 916-484-3011 <br /> Mailing Address PO BOX 15002 <br /> SACRAMENTO, CA 95851 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0005525 10,181,849 <br /> Facility Name TEICHERT-TRACY ROCK PLANT <br /> Location 29099 S MACARTHUR DR <br /> TRACY, CA 95377 <br /> Phone 209-832-4150 <br /> Mailing Address PO BOX 15002 <br /> SACRAMENTO, CA 95851 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 005-ORNELLAS, LEROY Fax <br /> APN 25312012 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> a <br /> Contact Name �)� PIC J4<-I <br /> SIU' <br /> Title <br /> Day Phone 41 <br /> r� p5 �tG� <br /> Night Phone �'�"/^���� �--- <br /> ACCOUNTS RECEIVABLE FILE INFORMATION J <br /> Account ID AR0006106 \g''� ���• �� New Account ID: <br /> Mail Invoices to Facility —� Mail Invoices to: Owner / Facility / Account <br /> Account Name TEICHERT-T CY ROCK PLANT /�' `�� (Circle One) <br /> Account Balance as of 3/20/2013: �7 .00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> —T9£T-HMBP-Reqular-Primary Location PR0519559 EE0002474-MICHAEL PARISSI --Active-- Y N A rl D <br /> x2326—�3M HW GEN<5 TONS/YR PRO513778 EE0002646-THUY TRAN —Aet+v Y N A W D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOPPRO511626 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> —q932--EXEMPT TANK FACILITY PR0502654 EE0000451 -STEVE SASSON Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PRO509338 EEOOOOOOO-HAZ MAT SJC OES Inactive Y N A D <br /> ,2&34—AST FAC >/= 1,320-<10 K GAL CUMULATI\jPRO535258 EE0002646-THUY TRAN =,=*@MPi- Y N A D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0523700 EE0004045-TED TASIOPOULOS Active Y N A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PR0533958 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form 1 also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. � E� I lU <br /> z� S <br /> APPLICANTS 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 I Recei d 3 <br /> REHS: (��� �py�ry ate / /�_ Account out: Date / ;PrU< <br /> COMMENTS: � L Y At S4 0�t,M f/{qC L ✓l Gl(J( r <br />