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Da(e - 5 2013 4:50:20PN SAN J 1UIN COUNTY ENVIRONMENTAL HE f�DEPARTMCNT Reporttl5ozl <br /> f <br /> Run by <br /> Facility Information as of 2/25/2013 Pagel <br /> Record Selection Criteria: f=acility ID FA0010986 <br /> Make changeslcorrections In RED ink. <br /> INFORMATION CHANGE(date) <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 />'I Owner DBA <br /> Owner Address PO BOX 608 DR - <br /> AUBURN, WA 98071 <br /> Horrie Phone 253-833-2777 <br /> Work/13usiness Phone 209-858-0225—Jk9:P-- <br /> Mailing Address. PO BOX 608 ' <br /> If AUBURN, WAD71 l <br /> I Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010986 <br /> Facility Name .OLDCASTLE PRECAST <br /> Location 15540 S MCKINLEY RD <br /> LATHROP, CA 95330 <br /> Phone 209-858-0225 _ <br /> 1 Mailing Address PO BOX 608 <br /> AUBURN, WA Q8971- <br /> Care of <br /> Location Code Alt Phone <br /> BOS District 003-BESTOLARIDES Fax <br /> APN 19806010 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION: <br /> Contact Name ERNEST JORDAN <br /> Title PLANT MANAGER <br /> Day Phone 209-858-0225 — <br /> I Night Phone 209-495-0796 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017986 New Account ID: : <br /> I. Mail Invoices to Facility Mail Invoices to: Owner 1 Facility 1 Account <br />! Account Name OLDCASTLE PRECAST (Circle one) <br /> Account Balance as of 212512013: $923.00 <br /> (Circle One) <br /> Transfer to Aativellnactve <br /> Program7Element and Description Record ID Employee ID and Name Status New owner? Delete <br /> 1921 -HMBP-Regular_f rimary Location PR51327-4 EE0002474-MICHAEL PARISSI Active Y N A I D <br /> 2220-SM HW_GEN<5TONSIYR PR0528654D EE0002646-THUY TRAN Active Y N A I D <br /> 2399=UNIFIED PROGRAM FAC'STATE SURCHAR(PRO510986 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC,<1,320 GAL PRO528653 EE0002646-THUY TRANI Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCH,PR0533334 Inactive Y N A I D <br />+ BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner;operator or agent of same acknowledge that all site,andlo projad specific,PHSlEHD hourly charges associated with this facility <br /> or activity will be biSled fq the party idant s the OwN[R on this form I also certify th operati s w be rfo ed in eccorda a SII epp[iesble Ordinance Cedes andlor Standards and Slate ardor <br /> Federal Laws J'ryI/` <br /> ' <br /> APPLICANTS SIGNATURE:: Date / 1 <br /> I <br /> s Program Records to be TRANSFERED: '$25.00= Amount Paid Date / 1 <br /> Water System to be TRANSFERED: Amount'Paid Dole 1 1 <br /> Payment Type Check Number Rece'v y <br />$ REHS: Date 1 I Account Nt: Date 1 1 <br /> k COMMENTS: <br /> 0 ,,•-� <br />