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Date run 7/24/2014 11:11:44AI SAN JO UIN COUNTY ENVIRONMENTAL HEA, T DEPARTMENT Rsport#5021 <br /> Run by `rl Page <br /> Facility Information as of 7/24/2014 <br /> Record Selection Criteria: Facility ID FA0009937 <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: 2 SSN/Fed Tax ID <br /> Owner ID OW0003379 New Owner lD <br /> Owner Name KELLOGG SUPPLY INC <br /> Owner DBA KELLOGG GARDEN PRODUCTS <br /> Owner Address 12686 E LOCKE RD <br /> LOCKEFORD, CA 95237 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-727-3130 <br /> Mailing Address 12686 E LOCKE RD <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009937 10183043 <br /> Facility Name KELLOGG GARDEN PRODUCTS <br /> Location 12686 E LOCKE RD <br /> LOCKEFORD, CA 95237 <br /> Phone 209-727-3130 x0 <br /> Mailing Address 12686 E LOCKE RD <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> Location Code 99- UNINCORPORATED P Alt Phone <br /> BOS District 004 -VOGEL, KEN Fax <br /> APN 05132011 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 AR0016937 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name KELLOGG GARDEN PRODUCTS (Circle One) <br /> Account Balance as of 7/24/2014: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inactre <br /> PrograMElement and Description Record ID Employee ID and Name Status New Owner! Delete <br /> 1921 -HMBP-Regular-Primary Location PRO521028 EE0008709-JAMIE DE LA ROSA Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PRO522232 EE0001422-ARIS VELOSO Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PRO512225 EE0000000-HAZ MAT SJC OES Inactiv( Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PRO509937 EE0000000-HAZ MAT SJC OES Inactivc Y N A I D <br /> 2831 -AST FAC >/=1,320-<10 K GAL CUMULATIVE PRO522233 EE0001422-ARIS VELOSO Active,l Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PRO531536 Inactivi Y N A I D <br /> BILLING arM COMPLIANCE ACKNOWLEDGEMENT'. I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project specific,PHSiEHD hourly charges associated with this facility <br /> or activity will be billetl 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 andor Standards and State andor <br /> Federal Laws. <br /> APPLICANT'S 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 Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br />