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F <br /> Date /2014 2:49:10PR SAN JOSPIN COUNTY ENVIRONMENTAL HEA*DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/22/2014 <br /> Record Selection Criteria: Facility ID FA0010287 <br /> Make changesicorrections in RED ink. <br /> INFORMATION CHANGE(date) S ZZ <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0008287 Case Number: 7614 New Owner ID <br /> Owner Name BRITZ-SIMPLOT GROWER SOLUTIONS <br /> Owner DBA BRITZ-SIMPLOT GROWER SOLUTIONS <br /> Owner Address 3265 W FIGARDEN DR <br /> FRESNO, CA 937113906 <br /> Home Phone Not Specified <br /> Work/Business Phone 559-448-8000 0 <br /> Mailing Address PO BOX 9050 <br /> FRESNO, CA 93790-9050 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0010287 10138541 Q �� <br /> Facility Name BRITZ-SIMPLOT GROWER SOLUTIONS <br /> Location 7707 S JACK TONE RD <br /> STOCKTON, CA 95215 <br /> Phone 209-461-6565 x0 <br /> Mailing Address PO BOX 9050 <br /> FRESNO, CA 93790-9050 <br /> Care of <br /> Location Code 99 - UNINCORPORATED P Alt Phone <br /> BOS District 005- ELLIOTT, BOB Fax <br /> APN 18117004 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 AR0017287 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility I Account <br /> Account Name BRITZ-SIMPLOT GROWER SOLUTIONS (Circle One) <br /> Account Balance as of 5122/2014: $0.00 (Circle One) <br /> Transfer to AcllvellnacNe <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR052i 174 EE0006044-LOWELL ALLEN Active Y N A I D <br /> 1962-CaIARP PROGRAM 2 FACILITY PRO530018 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 1995-CaIARP FAC STATE SURCHARGE FEE PRO522226 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO538425 EE0009001 -ELENA MANZO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512575 EE0000000-HAZ MAT SJC OES Inactive Y N A 1 D <br /> 2226-CaIARP PROGRAM PR0514757 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510287 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0530758 EE0007379-AMANDA BOERTIEN Active Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533a42 Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anclor project specific,PHSIEHD hourly charges associated with this facility <br /> 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 Ordinance Codes ander Standards and State andfor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Receiv y <br /> REHS: Date_/ /_ Account out: Date <br /> COMMENTS: <br />