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Date ren 6/3/2015 2:17:39PM SAN XW COUNTY ENVIRONMENTAL HEA DEPARTMENT Report 95021 <br /> Run by Pagel <br /> Facility Information as of 6/3/20 0 <br /> Record Selection Criteria: Facility ID FA0000649 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0000518 New Owner ID <br /> Owner Name CITY OF RIPON <br /> Owner DBA FORMER NESTLE USA INC FACILITY <br /> Owner Address 259 N WILMA AVE <br /> RIPON, CA 95366 <br /> Home Phone 209-599-2108 <br /> Work/Business Phone Not Specified <br /> Mailing Address 259 N WILMA AVE <br /> RIPON, CA 95366 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility lD/CERS ID FA0000649 <br /> Facility Name FORMER NESTLE USA INC FACILITY <br /> Location 230 INDUSTRIAL DR <br /> RIPON, CA 95366 <br /> Phone 209-599-2108 <br /> Mailing Address 800 N BRAND BLVD <br /> GLENDALE, CA 91203 <br /> Care of MARIE JOACHIM <br /> Location Code 05- RIPON Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 25938001 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000648 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ENVIRONMENTAL COST MANAGEMENT INC (Circle One) <br /> Account Balance as of 6/3/2015: $-375.00 <br /> (Circle One) <br /> Transfer to Aclive/Inactve <br /> Program/Dement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2229-GEN 50<250 TONS PERMIT PR0220104 EE0000005-FATINAH ZAREEF Inactive Y N A I D <br /> 2231-HAZARDOUS WASTE PBR FACILITY PR0527658 EE0000005-FATINAH ZAREEF Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0505647 EE0007289-ALISON YOUNGBLOOD Inactive Y N A I D <br /> 2960.RWQCB LEAD AGENCY CLEAN UP SITE PR0009051 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0460794 EE0005838-ADRIENNE ELLSAESSER Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anNor project speck,PHSEHD 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 hal all operations will be performed in accordance with all applicable Ordinance Codes andror Standards and State anclor <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 /> EHD Staff: Date_/ / Account out: Date—/ / <br /> COMMENTS: Invoice 1F: <br />