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Date ran 9/22/2004 1:34:18PK SAN J UIN COUNTY ENVIRONMENTAL HEAWH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 9/22/2004 <br /> Record Selection Criteria: Facility ID FA0004382 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner I OW0003297 New Owner ID <br /> Owner Name AMERON PIPE PROD <br /> Owner DBA AMERON INTERNATIONAL <br /> Owner Address 10100 W LINNE RD <br /> TRACY, CA 95376 <br /> Home Phone Not Specified <br /> Work/Business Phone 818-683-4000 <br /> Mailing Address 10100 W LINNE RD <br /> TRACY, CA 95377 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004382 <br /> Facility Name AMERON INTERNATIONAL <br /> Location 10100 W LINNE RD <br /> TRACY, CA 95377 <br /> Phone 209-836-5050 <br /> Mailing Address 10100 W LINNE RD <br /> TRACY, CA 95377 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN:25312041 <br /> BOS District 005-ORNELLAS, LEROY SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0004064 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name AMERON INTERNATIONAL (Circle One) <br /> Account Balance as of 9/22/2004: $0.00 <br /> (circle One) <br /> Transfer to Actwellnaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PRO511584 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2227-GEN 5<25 TONS PERMIT PR0507156 EE0007380-STEVEN SHIH Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0519505 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2390-ABOVEGROUND TANK(SPCC) PR0515795 EE0000451 -STEVE SASSON Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0507157 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0461181 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,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as me OWNER on this form. I also certify that all operations will be performed in accordance v th all applicable Ordinace Cortes 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 TRANSFERED: '$155.00= Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br /> \\phs-ehsql-nt\apps\envisions\reports\5021.rpt <br />