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Date win 1/15/2014 2:52:28Pk SAN JO AN COUNTY ENVIRONMENTAL HEA1,. Report#5021 <br /> DEPARTMENT pages <br /> Run by <br /> �l <br /> Facility Information as of 1/15/2014 <br /> Record Selection Criteria: Facility ID FA0003871 <br /> Make changesicorrections in RED Ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0002864 New Owner ID <br /> Owner Name UPS Freight <br /> Owner DBA UPS FREIGHT <br /> Owner Address 8400 PARDEE DR <br /> OAKLAND, CA 94621 <br /> Home Phone Not Specified <br /> WorktBusiness Phone 510-633-4035 <br /> Mailing Address 1000 Semmes Ave <br /> Richmond, VA 23224 <br /> Care of <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID/CERS ID FA0003871 10156117 <br /> Facility Name UPS Freight-Lathrop <br /> Location 1444 Lathrop Rd <br /> Lathrop, CA 95330 <br /> Phone 209-858-9134 x <br /> Mailing Address 8400 Pardee Drive, Attn: Plant Engineering <br /> Oakland, CA 94621 <br /> care of UPS Freight <br /> Location Code 07 - LATHROP Alt Phone <br /> BOS District 003 - BESTOLARIDES Fax <br /> APN Eli <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone 209-858-9144 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR00034 New Account ID: <br /> Mail Invoices to O) er Mail Invoices to. Owner / Facility / Account <br /> Account Name UPS Freight (Circle One) <br /> Account Balance as of 1/15/2014: $0.00 <br /> (Circle One) <br /> Transfer to ActiveMactve <br /> Proti am/Element and Description Record ID Employee ID and Name Status New Owne? Delete <br /> 0-HMBP-Common Materials PRO521200 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 27 -SM HW GEN 15 TONS/YR PRO538378 EE0002646-THUY TRAN Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0231638 EE0007289-ALISON YOUNGBLOOD InactivE Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0519162 EE0000000-HAZ MAT SJC DES Inactivc Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PRO524431 EE0002620-ALFONSO ARAMBULA Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO532359 InactivE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,adkoowledge that all site,ani project specific,PHSIEHD 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 andor Standards and State ani <br /> 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 Received by <br /> REHS: \ Date�_/ i/ I Account out: �J Date / // / <br /> COMMENTS: <br /> AOS pE 2220 U,A Ur_ L5 . <br /> per. �u-nu-f' <br />