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Date run 1/10/2012 10:13:32A1 SAN J ')UIN COUNTY ENVIRONMENTAL HE. IH DEPARTMENT Report#5D21Paget <br /> Run by Facility Information as of 1/10/2012 <br /> Record Selection Criteria: Facility ID FA0009739 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) _L0 L12_ <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN 1 Fed Tax ID <br /> Owner ID OW0007739 New Owner ID <br /> Owner Name LEHIGH SOUTHWEST CEMENT CO <br /> Owner DBA LEHIGH SOUTHWEST CEMENT CO <br /> Owner Address 2300 CLAYTON RD l a ui(p- 0`s <br /> CONCORD, CA 94520 P n <br /> Home Phone Not Specified _ <br /> Work/Business Phone <br /> Mailing Address PO BOX 2378 <br /> STOCKTON, CA 95201 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0009739 <br /> Facility Name LEHIGH SOUTHWEST CEMENT CO <br /> Location 2201 W WASHINGTON ST 1045 part <br /> STOCKTON, CA i C /7 CH 9 5 20 <br /> Phone 209-465-1921 -x0=- <br /> Mailing Address PO BOX 2378 <br /> STOCKTON, CA 95201 <br /> Care of <br /> Location Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax 2,01- 44.! - 0 <br /> APN 14502004 Email: I7Y SLCY7"--e - Q 2n eeA,.gik&y w& (� <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title TE.R <br /> C-y rnone 299 465-4994 1 209-4ori -1112-1 <br /> Night Phone 2t39-649-4499- 209- 4�Lo �2` 1/-17 — <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account to AR0016739 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner 1 Facility 1 Account <br /> Account Name LEHIGH SOUTHWEST CEMENT CO (Circle One) <br /> Account Balance as of 1/10/2012: $0.00 <br /> (Circle One) <br /> Transfer to Activellnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONSIYR PRO528534 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512027 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO520561 EE0000000-HAZ MAT SJC.OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAG STATE SURCHARIPRO509739 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2840-AST EXEMPT FAC < 1,320 GAL PRO528533 EE0001421 -STACY RIVERA Active,Exempt Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHPRO532179 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andlor project specific,PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. 1 also certify that all operations will be performed in accordance wth all applicable Ordinate Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: / 00 b Date 1 0 1 <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: Amount Paid Date 1 I <br /> Payment Type hec Number Recei <br /> REHS: Account out: Date <br /> COMMENTS' <br /> lleh-envlenvisi onlreports15021.rpt <br />