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4 , <br /> Date run 1/5/2014 4:09:13PM SAN JO UIN COUNTY ENVIRONMENTAL HEAT T'DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 6/5/2014 <br /> Record Selection Criteria: Facility ID FA0010456 <br /> Make changes/corrections in RED ink. -r I <br /> INFORMATION CHANGE(date) L <br /> OWNERSHIP CHANGE(date) t <br /> OWNER FILE INFORMATION Numberoff 'lilies for this owner 1 SSN/Fed Tax ID <br /> owner O�f� 56 se Number: H0813 New ow erlD <br /> Owne ame M tl'Marincic �IZI!)Llt 11A�1/7L. (� <br /> Ow r BA [CAL CO (STKN) <br /> Owner Addre 1010 INDUSTRIAL DR <br /> STOCKTON, CA 95206 L� <br /> Home Phone Not Specified <br /> Work/Business Phone 775-358-0888 <br /> Mailing Address 2302 Larkin Circle / <br /> SPARKS, NV 89431 <br /> Care of KINDER, STANLEY K <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FAD010456 10183569 <br /> Facility Name SIERRA CHIE��n1Y^}yICA��C�O (STK ) <br /> Location 1010 Nl (L.(_ �-�. <br /> STOCKTON, CA 95206 <br /> Phone 209-983-8298 x <br /> Mailing Address PO BOX 50730 <br /> SPARKS, NV 89435 �nwlw,M✓ <br /> Care of Lanny Hammock <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 17728053 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name _ <br /> Title <br /> Day Phone <br /> Night Phone ��, / < <br /> ACCOUNTS RECEIVABLE FILE INFORMATION IYL(tc I lu • �c�p3 0 Z r <br /> Account ID AR0017 56 NewAccdu"o S N� <br /> Mail Invoices to FaDj{j�Ad� Mail Invoices to: Owner / Facility / Account <br /> Account Name TERRA CH MICAL CO(STKN) (Circle One) <br /> Account Balance as of 6/5/2014: $0.00 <br /> (Circle One) <br /> Transfer to ActiveMactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0520328 EE0009817-ROBERT LOPEZ Active Y N A I D <br /> 1963-CaIARP PROGRAM 3 FACILITY PR0535192 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 1995-CalARP FAC STATE SURCHARGE FEE PR0518994 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0518741 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512744 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PR0514769 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510456 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO528832 EE0002622-BENJAMIN ESCOTTO Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0531938 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andVor project specific,PHS/EHD hourly charges associated with this facility <br /> or activity vAl be billed to the perry 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 andror <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 Tune — --fl eck Number Received by <br /> RENS: ` ��k./� Date / I K4Account out: /J Date_� <br /> COMMENTS: <br />