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Date /2014 10:36:39AM SAN JOAQ OUNTY ENVIRONMENTAL HEALTHWARTMENT Report#5021 <br /> Ru Pagel <br /> Facility Information as of 6/2/2014 <br /> Record Selection Criteria: Facility ID FA0004006 <br /> Make changesicorrections 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 OW0002948 New Owner ID <br /> Owner Name LEPRINO FOODS <br /> Owner DBA LEPRINO FOODS <br /> OwnerAddress 2401 MACARTHUR DR <br /> TRACY, CA 95376 0 <br /> Home Phone 800-537-7466 <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 173400 <br /> DENVER, CO 802173400 <br /> Care of EWING, JOHN <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0004006 <br /> Facility Name LEPRINO FOODS <br /> Location 2401 S MACARTHUR DR <br /> TRACY, CA 95376 <br /> Phone 209-835-8340 <br /> Mailing Address 2401 S MACARTHUR DR ►g 30 )A) 3gAyL <br /> TRACY, CA 95376 <br /> Care of GREENGRASS, ROY <br /> Location Code 03 -TRACY Alt Pa <br /> BOS District 005- ELLIOTT, BOB F <br /> APN 21307050 ail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name LEPRINO FOODS/ROY GREENGR <br /> Title <br /> Day Phone 209-835-8340 <br /> Night Phone 209-835-8340 n f� <br /> ACCOUNTS RECEIVABLE FILE INFORMATION W <br /> Account ID AR0003636 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name LEPRINO FOODS (Circle One) <br /> Account Balance as of 6/2/2014: $0.00 <br /> (Circle One) <br /> Program/Element and Description Record ID Em to a ID antl Name Transfer to Active/Inaclve <br /> P Ye Status New Owner? Delete <br /> 2960-RWQCB SITE PR0009269 EE0001699-JOHNNY YOAKUM Active 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,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the Party identified as the OWNER on this form. I also witty that all operations will be performed in accordance with all applicable Ordinance Codes anclor Standards and State anwor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: •$25.00= Amount Paid Date----L—/— <br /> Water <br /> ate_/ /Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / /_ Account out: Date��/_�/L l <br /> COMMENTS: <br />