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Date run 5/18/2020 3:35:43PK 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 FA0004094 <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: 3 SSN/Fed Tax ID <br /> Owner ID OW0000155 New Owner ID <br /> Owner Name JR SIMPLOT CO <br /> Owner DBA JRSIMPLOT CO <br /> OwnerAddress 16777 HOWLAND RD <br /> LATHROP, CA 95330 <br /> Work/Business Phone 209-858-2511 <br /> Alternative Phone Not Specified <br /> Mailing Address PO BOX 198 <br /> LATHROP, CA 95330-0198 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0004094 <br /> Facility Name J R SIMPLOT(OCCIDENTAL CHEMICAL) <br /> Location 16777 HOWLAND RD <br /> LATHROP, CA 95330 <br /> Phone 209-858-2511 <br /> Mailing Address PO BOX 198 <br /> LATHROP, CA 95330 <br /> Care of MURPHY, DONNA <br /> Location Code 07 - LATHROP Alt Phone <br /> BOS District 003 - PATTI, TOM Fax <br /> APN 19818005 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name DONNA MURPHY <br /> Title <br /> Day Phone 209-858-2511 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0003754 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ARCADIS (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? 0.facilryte <br /> 2960-RWQCB LEAD AGENCY CLEAN UP SITE PR0009015 EE0001699-JOHNNY YOAKUM Active Y N AD <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator o agent of same,acknowle ge that all site,andror project specific,PHS/EHD hourly charges associated with <br /> or activity will be billed to the party identified as the OWNER o is form. I also ify th all operations w'I be perfo ed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: _ Date <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date <br /> Water System to be TRANSF RED: Amount Paid Date <br /> Payment Type heck Number Receivedb / ��/ <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: C/ Invoice#: <br />