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Date run 9/23/2004 8:44:15AN SAN J(*IN COUNTY ENVIRONMENTAL HEAW DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/23/2004 <br /> Record Selection Criteria: Facility ID FA0000649 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner I OW0000518 New Owner ID <br /> Owner Name NESTLE FOODS CORP <br /> Owner DBA NESTLE FOODS CORP <br /> Owner Address 230 INDUSTRIAL <br /> RIPON, CA 95366 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-599-4161 <br /> Mailing Address 230 INDUSTRIAL <br /> RIPON, CA 95366 <br /> Care of NESTLE FOODS CORP <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0000649 <br /> Facility Name NESTLE/HILLS BROS <br /> Location 230 INDUSTRIAL DR <br /> RIPON, CA 95366 <br /> Phone 209-599-4161 <br /> Mailing Address 800 N BRAND BLVD <br /> GLENDALE, CA 91203 <br /> Care of BINAYAK A CHARYA <br /> Location Code 05- RIPON APN:25938013 <br /> BOB District 005 -ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0000648 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name NESTLEMILLSBROS (Circle One) <br /> Account Balance as of 9/23/2004: $0.00 <br /> (Circle One) <br /> Transfer to Activellmctve <br /> ProgramlElement and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2229-GEN 50<250 TONS PERMIT PR0220104 EE0000988-KASEY FOLEY Inactive Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84) PR0505647 EE0007289-ALISON YOUNGBLOODInactive Y N A I D <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0009051 EE0007479-RON ROWE Active Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0460794 EE0000756-CAROL OZ Inactive 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,PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the parry idenMed 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 /> APPLICANTS 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 / I Account out: Date <br /> COMMENTS. <br /> \\Dhs-ehsq I-nt\apps\envisions\reports\5021.rpt <br />