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u <br /> I` Da313!2014 10:29:28AM "SAN JOAMAIN COUNTY ENVIRONMENTAL HEAL EPARTMENT Report <br /> te run <br /> Run by Pagel <br />$ 3 Facility Information as of 3/3/2014 <br /> Record Selection Criteria: Facility ID FA0010986 <br /> Make changeslcorrections in RED ink, <br /> INFORMATION CHANGE(date) �. F•' f <br /> ',i <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0012761 New Owner ID <br /> Owner Name OLDCASTLE PRECAST INC <br /> Owner DBA <br /> Owner Address 1002 15TH ST <br /> I AUBURN, WA 98001 <br /> Home Phone,253-833-2777 <br /> Work/Business Phone 209-858-0225 <br /> Mailing Address PO BOX 727 <br /> PLEASANTON, CA 94566 <br /> Care of <br /> tl FACILITY FILE INFORMATION <br /> Facility 10/CERSID FA0010986 10,184,013 <br /> Facility Name OLDCASTLE PRECAST <br /> Location 15540 S MCKINLEY RD" <br /> LATHROP, CA 95330 <br /> Phone 209-858-0225 <br /> Mailing Address PO BOX 727 <br /> PLEASANTON, CA 94566 <br /> Care of <br /> I Location Code Alt Phone <br /> BOS District 003- BESTOLARIDES Fax <br /> APN 19806010 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ERNEST JORDAN <br /> Title PLANT MANAGER <br /> Day Phone 209-858-0225 <br /> Night Phone 209-495-0796 <br /> I t <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID :AR0017986 New Account ID: <br /> }" Mail Invoices to Facility Mail Invoices to: Owner / Facility 1 Account <br /> Account Name OLDCASTLE PRECAST (Circle One) <br /> Account Balance as of 3/3/2014: $923:00 <br /> (Circle One) <br /> Transferto Aclivellnactve <br /> ProgramlElement and Description .Record ID Employee ID and Name -Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PR0513274 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW GEN<5 TONS/YR PR0528654 EE0002646-THUY TRAN Active Y N A D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F PR0510986 EE0000000-'HAZ MAT SJC OES Inactive Y N A D <br /> t. 2840-AST EXEMPT FAC <-1,320 GAL- PRO528653 EE0002646-THUY TRAN Active,! Y N' A D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARG PR0533334' Inactive Y N A 1 D <br /> I ki. <br /> f BELLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges assoclated 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 andlor Standards and State andlor <br />{ Federal Laws. - <br /> r <br /> APPLICANT'S SIGNATURE: Date I I <br /> Program Records to be TRANSFERED: .$25.00= Amount Paid Date 1 1 <br /> Water System to be TRANSFERED: Amount Paid Date ! 1 <br /> Payment Type Check Number Received by <br /> RENS: j;�--_rye_,L i`t � Date��I / Account out: Date I <br /> COMMENTS <br /> r <br /> I �� tf4-T" `�i'r3.-F"�r c-i L�-7-yi .K ��J✓.� "�` ci'.��'" �� ��'� �C''F.c.-� � � � <br /> 31 <br />