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Date run 4/14/2009 11:10:29AI SAN JC `UIN COUNTY ENVIRONMENTAL HEA) _ { DEPARTMENT Report#5021 <br /> Run by 4006 Pagel <br /> Facility Information as of 4/14/20L o <br /> Record Selection Criteria: Facility ID FA0015259 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0012238 New Owner ID <br /> Owner Name CHIPA PROPERTIES INC <br /> Owner DBA <br /> Owner Address PO BOX 116 <br /> NEWPORT BEACH, CA 92662 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 116 <br /> NEWPORT BEACH, CA 92662 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015259 <br /> Facility Name WEST COAST TOMATO OF CA LP <br /> Location 2900 E HARDING WAY <br /> STOCKTON, CA 95205 <br /> Phone 941-722-4545 <br /> Mailing Address 2900 E HARDING WAY <br /> STOCKTON, CA 95205 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 001 - GUTIERREZ, STEVE Fax <br /> APN 14310020 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0026265 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name GROUND ZERO ANALYSIS INC✓ (Circle One) <br /> Account Balance as of 4/14/2009: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner.) Delete <br /> 2950-ENVIRON ASSESS PR0522425 EE0003611 -FRANK GIRARDI 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 TRAIySFERED: '$372.00= Amount Paid 431 ' Date / <br /> Payment Type �/ Check Number Received by. <br /> REHS: — � Date / / Account out: Date <br /> COMMENTS: <br /> \\eh-env\en vision\reports\5021.rpt <br />