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Date run 6/5/2014 9:01:58AM SAN J( 7IN COUNTY ENVIRONMENTAL HEA1 DEPARTMENT Report#5021 <br /> Pagel <br /> Run by Facility Information as of 6/512014 <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 6d^-1- �.`+O_00 <br /> Mailing Address 23623 S BIRD RD <br /> TRACY, CA 95304 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/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 Alt Phone b0 <br /> BOS District 005 - ELLIOTT, BOB Fax t7- <br /> APN 25010003 EMail: -- <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION ir <br /> Contact Name �IGL _ <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 / Facility I Account <br /> Mail Invoices to Owner <br /> (Circle one) <br /> Account Name SHIMMICK CONSTRUCTION CO INC <br /> Account Balance as of 6/5/2014: $0.00 (Circle One) <br /> Transferor Activeflnactva <br /> jgmmlEtement and Description Record ID Employee ID and Name Stains New Owner? Delete <br /> TM <br /> Iy1921 -HMBP-Regular-Primary LocaY 1 '"( PRO529204 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> '-p2226-•SIVI HW GEN<5 TONS/YR �4,-2 �r t� PRO538561 EE0002646-THUY TRAN Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATES RCHARG PRO532820 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,endo,project specific,PHSIEHD hourly charges associated with this fadiity on <br /> wl <br /> 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 anNor Standards and State endor Federal Laws. <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 Recel y <br /> RENS: I7� -�VfnJyr1r��Datel �yT�/_/ Ac-c7o�unt out: Date�JG <br /> COMMENTS:�W II �� Ur l/✓`w'�v ICS ps�rp�� a�d/�� <br /> L1700� I <br />