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Date run 7/27/2004 8:24:33AN SAN JUIN COUNTY ENVIRONMENTAL HEI DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 7/27/2 4 <br /> Record Selection Criteria: FacilityID FA0004443 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0003358 New Owner ID <br /> Owner Name ROBERT MONDAVI ENTERPRISES INC <br /> Owner DBA ROBERT MONDAVI WINERY <br /> Owner Address PO BOX 1260 <br /> WOODBRIDGE, CA 95258 <br /> Home Phone Not Specified <br /> Work/Business Phone 707-226-1395 <br /> Mailing Address PO BOX 1260 <br /> WOODBRIDGE, CA 95258 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0004443 <br /> Facility Name ROBERT MONDAVI WINERY <br /> Location 5950 E WOODBRIDGE RD <br /> ACAMPO, CA 95220 <br /> Phone 209-369-5861 <br /> Mailing Address PO BOX 1260 <br /> WOODBRIDGE, CA 95258 <br /> Care of <br /> Location Code 99- UNINCORPORATED AREA APN:01709058 <br /> BOS District 004-SEIGLOCK, JACK SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0004125 NewAccount ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ROBERT MONDAVI WINERY (Circle One) <br /> Account Balance as of 7/27/2004: $30.00 <br /> (Circle One) <br /> Transfer to Activellnacive <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2214-CalARP FAC STATE SURCHARGE FEE PR0518992 EE0003580-MICHELLE LE Active Y N A I D <br /> 2220-SM HW GEN<5 TONSNR PR0513738 EE0003580-MICHELLE LE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO PR0511557 EE0000000-HAZ MAT SJC DES Active Y N A I D <br /> 2226-CalARP PROGRAM PR0514548 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PR0519507 EE0000000-HAZ MAT SJC IDES Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84) PR0503699 EE0003580-MICHELLE LE Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SERVICE FPR0509269 EEo000o00-HAZ MAT SJC OES Inactive Y N A I D <br /> 4630-NTNC WATER SYSTEM WA0461282 EE0000644-TED NORGARD 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 /> Stale and/or Fedeml 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-ehsgl-nt\apps\Envisions\Reports\5021.rpt <br />