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Date run 3/2,0/2013 3:48:40PN SAN JO UIN COUNTY ENVIRONMENTAL HEA I DEPARTMENT Repod#5021 <br /> Run b.y WPagel <br /> Facility Information as of 3/20/2013 <br /> Record Selection Criteria: Facility ID FA0006174 <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 OW0004923 New Owner ID <br /> Owner Name EARTH GRAINS BAKING CO. <br /> Owner DBA EARTHGRAINS BAKING CO INC THE <br /> Owner Address 2651 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address 2651S AIRPORT WAY <br /> STOCKTON, CA 952063599 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0006174 10,182,041 <br /> Facility Name EARTHGRAINS BAKING CO INC <br /> Location 2651 S AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Phone 209-946-0772 _ <br /> Mailing Address 2651 S AIRPORT WAY _ <br /> Care of �n <br /> STOCKTON, CA 952063599 djograj nS Ba <br /> Location Code 01 -STOCKTON <br /> BOIS District 001 -VILLAPUDUA _ <br /> APN 16912003 EQ P2 ox Cl I(O <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION r,��� � PA 'q 04 <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0007255 <br /> Mail Invoices to Facility ount <br /> Account Name EARTHGRAINS BAKING CO INC <br /> Account Balance as of 3/20/2013: $250.00 <br /> (Circle One) <br /> Transfer to Activellnadve <br /> PrograrvElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO519612 EE0009817-ROBERT LOPEZ Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513821 EE0001421 -STACY RIVERA Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOWR0511699 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0504354 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR(PRO509411 EEOOO0000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC <1,320 GAL PRO531049 EE0001421 -STACY RIVERA Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0528634 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHrPR0532299 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor protect specific,PHS/EHD hourly charges associated with Nis facility <br /> or activity will be billed to the party identified as Me OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andor Standards and State ands <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 Rece <br /> ry <br /> REHS: Date / / Account out: Date / /_1L3_ <br /> COMMENTS: <br />