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Date run 7118/200812:39'40PI SAN JO,.,JINCOUNTY ENVIRONMENTAL HEALNIDEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 7/18/2008 Pagel <br /> Record selection Criteria: Facility ID FA0009519 <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 OW0007519 Case Number: H04697 New Owner ID <br /> Owner Name HORMEL FOODS CORP <br /> Owner DBA HORMEL FOODS CORPORATION <br /> Owner Address <br /> Home Phone Not Specified <br /> Work/Business Phone -50-743-7561 <br /> Mailing Address PO BOX 100 <br /> STOCKTON, CA 95201 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009519 <br /> Facility Name HORMEL FOODS CORPORATION <br /> Location 1404 S FRESNO AVE <br /> STOCKTON, CA 95206 <br /> Phone -20-994-3541 <br /> Mailing Address PO BOX 100 <br /> STOCKTON, CA 95201 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 - GUTIERREZ, STEVE Fax <br /> APN 163-050-24 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 AR0016519 New Account ID: <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility ! Account <br /> Account Name HORMEL FOODS CORP (Circle One) <br /> Account Balance as of 7/18/2008: $0.00 <br /> (Circle One) <br /> Transfer to ActNe/Inadve <br /> Program/Element and Description Record ID Employee ID and Name status New Omer? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0513881 EE0008317-RAYMOND VON FLUE Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511807 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PR0519695 EE0000000-HAZ MAT SJC IDES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR43RO509519 EE0000000-HAZ MAT SJC IDES Inactive Y N A �.r D <br /> 836-AST FAC>/=100 M t 1 GAL CUMULATIVE PRO516366 EE0008317-RAYMOND VON FLUE Active/ Y N A `(���} D <br /> BILLING amJ COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project spec,PHS/EHD hourly charges assoda ad with this <br /> /Scilly or ad"you be billed to the parry identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordmace Codes and/or Standards and <br /> Slate andlor Fed"Laws. <br /> pCU7 <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date II <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date <br /> Payment Type Check Number Receiv <br /> REHS: Date / / Account out: Date <br /> COMMENTS' <br /> l -32 Zo GLorj <br /> \\phs-ehsgl-nt\apps\envisions\reports\5021.rpt <br />