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Date run 8/19/2003 8:29:33AN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Pagel <br /> Run by Facility Information as of 8/19/2003 <br /> Record Selection Criteria: Facility ID FA0014575 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> r <br /> Owner ID OW0011596206! New Owner ID <br /> Owner Name TEICHERT AGGREGATES <br /> Owner DBA <br /> Owner Address 3500 AMERICAN RIVER DR <br /> SACRAMENTO, CA 95864 <br /> Home Phone 916-484-3351 <br /> Work/Business Phone Not Specified <br /> Mailing Address 3500 AMERICAN RIVER DR <br /> SACRAMENTO, CA 95864 <br /> Care of TEICHERT GGREGATE9- 00 <br /> FACILITY FILE INFORMATION Site Mitigate n Facility <br /> Facility ID FA0014575 <br /> Facility Name TEICHERT AGGREGATES JIM SEIBEL <br /> Plant Manager <br /> Location 29099 S MACARTHUR RD <br /> TRACY, CA 95376 - <br /> Phone A & <br /> TEICHERT <br /> ICHERT AGGREGATES <br /> Mailing Address 29099 S MACARTHUR RD <br /> TRACY, CA 95376 <br /> Care of TEICHERT AGGREGATES <br /> Location Code <br /> 29099 SOUTH MACARTHUR DR.•TRACY,CA 95377 <br /> BOS District (209)832-4150•FAX(209)835-3768•Cell(209)969-5891 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0024811 NewAcco nt ID: <br /> Mail Invoices toAcce"Irff Mail Invoices to: Owner Facility / Account <br /> Account Name PLANE STRIES INC (Circle One) <br /> Account Balance as of 8/19/2003: $694.20 <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 PR0521467 EE0000684-MICHAEL INFURNA Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: 1,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 T NSFERED: '$155.00= Amount Paid Date <br /> Payment T e Check Number Received by 63 <br /> RENS: Date / / Account out: Date <br /> COMMENTS: <br /> \\Phs-ehsql-nt\apps\Envisions\Reports\5021.rpt )POO" �+� <br />