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Date run 5/18/2020 3:43:48PN SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/18/2020 <br /> Record Selection Criteria: Facility ID FA0024220 <br /> Make changes/corrections 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 OW0022755 New Owner ID <br /> Owner Name GLENN SPRINGS HOLDINGS INC <br /> Owner DBA <br /> OwnerAddress 5 GREENWAY PLZ 110 <br /> HOUSTON, TX 77046 <br /> Work/Business Phone Not Specified <br /> Alternative Phone Not Specified <br /> Mailing Address 5 GREENWAY PLZ STE 110 <br /> HOUSTON, TX 77046 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0024220 <br /> Facility Name FORMER OCC LATHROP FACILITY <br /> Location 16777 HOWLAND RD <br /> LATHROP, CA 95330 <br /> Phone <br /> Mailing Address 5 GREENWAY PLZ STE 110 <br /> HOUSTON, TX 77046 <br /> Care of <br /> Location Code 07 - LATHROP Alt Phone <br /> BOS District Fax <br /> APN 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 AR0045051 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ARCADIS US INC (Circle One) <br /> Account Balance as of 5/18/2020: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? ete <br /> 2960-RWQCB LEAD AGENCY CLEAN UP SITE PR0542173 EE0000418-MICHAEL KITH Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acowledge that all site,ancl/or project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER his form. I also ce ' that all operations will b performed in accordance with all applicable Ordinance Codes and/or Standards and State andlor <br /> Federal Laws. <br /> VU <br /> APPLICANT'S SIGNATURE: Date r—/ ` (� <br /> Program Records to be TRANSFE $25.0 ��C�Paid Date <br /> Water System to be TRANSFERE . nt Paid Date <br /> Payment Type Check Number Received S <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> Invoice#: <br />