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Date run ' T2/7/2010 11:43:55AI SAN JOI$UIN COUNTY ENVIRONMENTAL HEA H DEPARTMENT Report#5021 <br /> Run by 1273 Pagel <br /> Facility Information as of 12/7/2 <br /> Record Selection Criteria: Facility ID FA0014439 <br /> ' ( Make changes/corrections in RED ink. <br /> I w 1 iy INFORMATION CHANGE(date) <br /> ! / OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011481 New Owner ID <br /> Owner Name DOLE PACKAGED FOODS LLC-STKN <br /> Owner DBA <br /> Owner Address 7916 W BELLEVUE RD <br /> ATWATER, CA 95301 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-358-5643 _ <br /> Mailing Address 7916 W BELLEVUE RD <br /> ATWATER, CA 95301 <br /> Care of SCHLEFSTEIN, MICHELLE <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0014439 <br /> Facility Name DOLE PACKAGED FOOD LLC-STKN <br /> Location 1668 EL PINAL DR <br /> STOCKTON, CA 95205 <br /> Phone 209-337-0490 <br /> Mailing Address 7916 W BELLEVUE RD f Ile <br /> ATWATER, CA 95301 S tj <br /> Care of SCHLEFSTEIN, MICHELLE &'14AE- �DR Z— <br /> Location Code 01 -STOCKTON AIt'Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 11736042 EMail: I r t20-14AE1- , 4<9 RaZ C dol , Ce W1 <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DOWNES, RAY <br /> Title DIRECTOR OF OPERATIONS <br /> Day Phone 209-337-0490 <br /> Night Phone 209-489-0605 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024519 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name DOLE PACKAGED FOOD LLC-STKN (Circle One) <br /> Account Balance as of 12/7/2010: $-106.50 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0535436 EE0004636-GARRETT BACKUS Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO519297 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PR0533138 Active 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 <br /> facility 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 Ordinace Codes and/or Standards and <br /> State and/or 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 Receiv d/p <br /> REHS: Date / / Account out: -----J --_ Date <br /> COMMENTS: <br /> �h <br /> \\eh-env\envision\re ports\5021.rpt <br />