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Run by : STAFF S~ Joaquin County PHS/EHD Report #5021 <br /> FACILITY INFORMATION as of 03/26/96 <br /> - - - - - - - - -- - - - -- -- - - - - - -- - - ---- --- - - ----- --- --- - ------ ----- - --- -- ------ <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date) : <br /> OWNERSHIP CHANGE (date) : <br /> OWNER ID: 002811 New Owner ID: 00 <br /> Owner Name: ES FORMES, 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 /> care of: ESFORMES,NATE/SAMPLE, TERRY <br /> TRACY, CA 95378 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 003785 <br /> Facility Name: TRIPLE E PRODUCE CORP <br /> Location: 8690 W LINNE RD AGRO ENVIRONMENTAL SERVICES�L� ���5�u <br /> TRACY 95376 <br /> Phone: 209-948-1155 _ ROBERT C. DIXON - <br /> Mailing Address: PO BOX 239 _ <br /> Certified Professional Agronomist <br /> Care of: TRIPLE E PRODUCE CORP Consultant to Agriculture — <br /> TRACY, CA 95378 2719 Sheridan way 6S� — <br /> Stockton, CA 95207 N — <br /> Location Code: 99 APN: (209) 474-1492 �"i-eC-3 <br /> BOS District: SIC Code: <br /> Sfz�tcf�-�G <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0003369 New Account ID: 000 <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 03/26/96 : $0 . 00 (Circle one) <br /> Record UST(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> ----- ----- ---- -- ---------------- ---------- --------------------------------- ---- <br /> 2960 RWQCB CLEAN UP SITE PR009063 0684 INFURNA ACTIVE Y N A I D <br /> 2381 UST FACILITY (BEFORE 1/84) PR231647 1968 YOSHIOKA INACTIVE 2 Y N A I D <br /> 4630 NTNC WS WA461309 0467 ACTIVE Y N A I D <br /> ----- -- --- - -- - - - - - - - - - - - - ----- - - - ------- ----- ----------------------- ----------- <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> -------------- ---------- -------- ---- - ----- - -- ------- ---------- -- --- --- --------- <br /> PR Records to be TRANSFERED: x $20.00 = Amount Paid Date <br /> Water System to be TRANSFERED: x $150.00 = Amount Paid Date <br /> Payment Type Check 4 Recvd by <br /> ------------------------------------------------------ <br /> REHS or COUNTER SUPV: Dace—/—/ ACCT out: Date—/—/ UNIT/File:—/—/ <br />