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Date run 6/18/2018 12:10:21 PI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by , Pagel <br /> Facility Information as of 6/18/2018 <br /> Record Selection Criteria: Facility ID FA0019471 <br /> Make changestcorrections 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 /> OwnerAddress 23623 S BIRD RD <br /> TRACY, CA 95304 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-830-6500 <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 Shimmick Construction Co. Inc <br /> Location Code 99- UNINCORPORATED A Alt Phone <br /> BOS District 005 - ELLIOTT BOB Fax <br /> APN 25010003 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name KEITH WOOD <br /> Title EQUIPMENT SUPERVISOR <br /> Day Phone 209-833-8682 <br /> Night Phone 510-715-8466 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0034621 NewAccount ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name SHIMMICK CONSTRUCTION CO INC (Circle One) <br /> Account Balance as of 6/18/2018: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Reqular-Primary Location PR0529204 EE0000009-NICHOLAS LOEHRER Active Y N A I D <br /> 2227-GEN 13<25 TONS PERMIT PR0538561 EE9999997-TWO VACANT2 Active Y N A I D <br /> 2831 -AST FAC >/= 1,320-<10 K GAL CUMULATIVE PRO538998 EE9999997-TWO VACANT2 Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0532820 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. I 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. <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 Received by <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: /� NVQ '�`'� <br /> 1 Q CA C han q b T 1, oI ' t Invoice#: <br /> .Tu aaa C. <br />