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07/14/2005 14: 18 4640138 ENVIRONMENT/' '-AEALTH PAGE 02 <br /> Date run 7114/2005 1:48:29Ph SAN t,QUIN COU.NTV ENVIRONMENTAL HEA 1'TH DEPARTMENT Ropen05021 <br /> Run by 4006 ... Facility Information as of 7/14/2005 Paget <br /> i Record Selection CHirri�: Fncirty 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 OW000281 1 New Owner ID <br /> Owner Name ESFORMES, NATE <br /> Owner DBA TRIPLE E PRODUCE CORP QC, iC TZ.Ole E, !_TIF, <br /> Owner Address PO BOX 239 <br /> TRACY, CA 95378 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-835-5123 <br /> Mailing Address PO BOX 239 <br /> TRACY, CA 95378 <br /> Care of <br /> FACILITY FILE INFORMATION -rA k/ -W- 9Q-a5r7*7gq Q, <br /> Facility ID FA0003785 <br /> Facility Name TRIPLE E PRODUCE CORP 9tLG4ic IK 1E E_t LID- <br /> Location 8690 W LINNE RD <br /> TRACY, CA 95376 <br /> Phone 209-835-5123 <br /> Melling Address 8650 W LINNE RD <br /> TRACY, CA 95376 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN:25321018 <br /> DOS District 005-:.ORNELLAS, LEROY SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003369 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name ESFORMES, NATE (Crave one) <br /> Account Balance as of 7/14/2005: $363.00 <br /> (circa.One) <br /> Transfer to ActWnacly« <br /> Programivament and Descriptlen Record ID Employee 10 and Name Status New Own"r7 Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHOR ILATiOIPR0511899 EE0000000-HAZ MAT SJC OES Inactive Y N A 1 D <br /> 2244-PACT TRANSFER RECORD-OES PRO519770 EE0000000-HAZ MAT SJC OES Activ Y N A 1 D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0231847 EE0000451 -STEVE SASSON Y N A 1 D <br /> 2390-ABOVEGROUND TANK(SPCC) PRO516490 FE0006976-AL OLSEN Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARiPRO509611 EE0000000-HAZ MAT SJC CES ve Y N A 1 D <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0009063 EE0000684-MICHAEL INFURN Active Y N A 1 b <br /> 4830.NTNC WATER SYSTEM WA0481309 EE0001699-JOHNNY YOAKUM ve Y N A 1 D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT I,the undersigned owner,operetof or agent of same,acknowledge that oil site,and/or prv)net apecft,PMS/EHD hourly charges Associated VAh this <br /> facility or activity vAl be billed to the party identified ha 0 on this form. 1 I•o oertl!'y that aB operationt wet be performed In accordance�,fm all appllc0bre Ording"Codes and/or Standards end <br /> State and/or Federal Lows, y <br /> APPLICANT'S SIGNATURE Date <br /> Program Records to be TRANSFERED: $ 0 Amount Paid Date / <br /> Water System to be TRANSFEREO: $155,000/-IL—Amount Paid Data <br /> Payment Type Check Number Receivedby <br /> �,� <br /> REHS: Date I J Account out: Date '7_l <br /> COMMteNT6; <br /> N C t3 <br /> 1 U L 1 8 2005 <br /> \\Phs-ehSgl-nt\apps\envisions\rewrts\5021.rpt BWRO �MENE 10E TH <br />