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Date run 8/27/2010 2:27:38PK SAN X ZUIN COUNTY ENVIRONMENTAL HEP A DEPARTMENT Report 15021 <br />Run by ^7T0 Paget <br />Facility Information as of 8/27/20 <br />nr:,.,,,,, ��,�,.,,w, �a�,��w rnuuuaal f <br />OWNER FILE INFORMATION <br />Owner ID <br />OW0007917 Case Number: H05810 <br />Owner Name <br />PAT MITCHELL <br />Owner DBA <br />CALIFORNIA NATURAL PRODUCTS <br />Owner Address <br />1250 E LATHROP RD <br />209-858-2525 <br />LATHROP, CA 95330 <br />Home Phone <br />Not Specified <br />Work/Business Phone <br />209-931-9502 <br />Mailing Address <br />PO BOX 1219 <br />N <br />LATHROP, CA 95330 <br />Care of <br />APN <br />FACILITY FILE INFORMATION <br />Facility ID <br />FA0009917 <br />Facility Name <br />CALIFORNIA NATURAL PRODUCTS <br />Location <br />1250 E LATHROP RD <br />,J <br />:t <br />CMN <br />LATHROP, CA 95330 <br />Phone <br />209-858-2525 <br />Mailing Address <br />PO BOX 1219 <br />LATHROP, CA 95330 <br />Care of <br />PAT MITCHELL <br />Location Code <br />N <br />BOS District <br />003 - BESTOLARIDES <br />APN <br />198-040-01-0 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name PAT MITCHELL <br />Title QWAJ.— <br />Day Phone 209-858-2525 <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0016917 <br />Mail Invoices to Facility <br />Account Name CALIFORNIA NATURAL PRODUCTS <br />Account Balance as of 8/27/2010: $0.00 <br />Make changes/corrections in RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />SSN / Fed Tax ID <br />New Owner ID : <br />Site Mitigation Facility <br />Alt Phone <br />Fax t58-z5s6 <br />EMail : <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle Ore) <br />(Circle ore) <br />Transferor Active/Inxne <br />Pr m/ lament and <br />asRecord ID <br />Employee ID and Name <br />Status <br />New Owner? <br />Delete <br />,J <br />:t <br />CMN <br /><5 TS7;2.4 <br />/YRT PR0517883 <br />EE0002646 - THUY TRAN <br />Active <br />Y <br />N <br />A <br />I D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512205 <br />EE0000000 - HAZ MAT SJC DES <br />Inactive <br />Y <br />N <br />A <br />I D <br />2244 - PACT TRANSFER RECORD - OES PR0519959 <br />EE0000000 - HAZ MAT SJC OES <br />Active <br />Y <br />N <br />A <br />I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHARPR0509917 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A <br />I D <br />ERSC - ELECTRONIC REPORTING SURCHARGE PR0534671 <br />Active <br />Y <br />N <br />A <br />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 wih the <br />facility or activity will be billed to the party identified as the OWNER on this form. I also car* that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br />Stale aM/or Federal Laws, <br />APPLICANT'S SIGNATURE: <br />Date / <br />Program Records to be TRANSFERED: ` $20.00 = Amount Paid Date / / <br />Water System to be TRANSFERED: ' $372.00 = Amount Paid Date <br />Payment Type �— Check Number Receiv <br />REHS: ���'t'- --�,�1.f�iL. Date / / Il) Account out: Date I l <br />COMMENTS: J / <br />\\eh�nv\envisionVeports\5021.rpt <br />