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Date run 4/29/2002 12:05:51 PI SAN JO JUIN COUNTY ENVIRONMENTAL HEA '3 DEPARTMENT Report#5021 <br /> Run by -Up. — Pagel <br /> Facility Information as of 4/29/2002 <br /> Record Selection Criteria Facility ID FA0003785 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0002811 New Owner ID <br /> Owner Name ESFORMES, NATE <br /> Owner DBA TRIPLE E PRODUCE CORP <br /> Owner Address PO BOX 239 <br /> TRACY, CA 95378 <br /> Home Phone 209-835-5123 <br /> Work/Business Phone 209-948-1155 <br /> Mailing Address PO BOX 239 <br /> TRACY, CA 95378 <br /> Care of ES FORM ES,NATE/SAM PLE,TERRY <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0003785 <br /> Facility Name TRIPLE E PRODUCE CORP <br /> Location 8690 W LINNE RD <br /> TRACY, CA 95376 <br /> Phone 209-948-1155 <br /> Mailing Address PO BOX 239 <br /> TRACY, CA 95378 <br /> Care of TRIPLE E PRODUCE CORP <br /> Location Code 99 - UNINCORPORATED AREA APN: <br /> BOS District 005 - BEDFORD, LYNN SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003369 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name TRIPLE E PRODUCE CORP (Circle One) <br /> Account Balance as of 4/29/2002: $1.10 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511899 EE0o00000-HAZ MAT SJC OES Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84) PR0231647 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PR0516490 EE0o00000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509611 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2960-RWQCB CLEAN UP SITE PR0009063 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0461309 EE0001699-JOHNNY YOAKUM 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: *$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS. <br /> O O"D <br /> \\Phs-ehsgI-nt\apps\Envision s\Reports\5021.rpt <br />