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812:35:09PI SAN JO%sei)INCOUNTY ENVIRONMENTAL HEAi1woll.DEPARTMENT Report#5021 <br /> Pagel <br /> Facility Information as of 7/21/2008 <br /> - ion Criteria Facility ID FA0009522 <br /> i <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0007522 Case Number: H04721 New Owner ID <br /> Owner Name THE MARTIN-BROWER CORP <br /> Owner DBA MARTIN-BROWERCO THE <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/BusinessPhone 630-271-8300 <br /> Mailing Address PO BOX 31720 <br /> STOCKTON, CA 952131720 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009522 <br /> Facility Name MARTIN-BROWER CO THE <br /> Location 900 N SHAW RD <br /> STOCKTON, CA 95215 <br /> Phone 209-460-3393 <br /> Mailing Address PO BOX 31720 <br /> STOCKTON, CA 952131720 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 14327061 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016522 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MARTIN-BROWERCO THE (Circle One) <br /> Account Balance as of 7/21/2008: $0.00 <br /> (Circle One) <br /> Transrer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner' Delete <br /> 2214-CalARP FAC STATE SURCHARGE FEE PR0518977 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0513882 EE6666666-Toua Alias-Yang Inactive Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511810 EE0000000-HAZ MAT SJC DES Inactive Y N A I D <br /> 2226-CaIARP PROGRAM PRO514608 EE0000000-HAZ MAT SJC DES Inactive Y N A D <br /> SPACT TRANSFER RECORD-OES PRO519698 EE0000000-HAZ MAT SJC DES Inactive Y N A D <br /> 390 ABOVEGROUND TANK(SPCC) PRO516659 EE0000008-LETITIA BRIGGS Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR,PR0509522 EE0000000-HAZ MAT SJC OES Inactive 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 ass also 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 Oroinace Codes and/o tandards and <br /> tate and/or a awe._71'? ' —0 <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Recall N� <br /> REHS Date / / Account out: Date l T i2 <br /> COMMENTS: <br />