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72 <br /> Date run 1!1012012 9:37:07Af1 Report 95021 <br /> SAN "!UIN COUNTY ENVIRONMENTAL HES-`{ DEPARTMENT Paget <br /> Run by Facility Information as of 1/10/2012 <br /> Record Selection Criteria: Facility ID FA0009739 <br /> J Make changesicorrections in RED ink. <br /> ! <br /> INFORMATION CHANGE(date) / <br /> v 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 <br /> CONCORD, CA 94520 1--;-(P l Dw <br /> Home Phone Not Specified <br /> Work/Business Phone 925-669--li x' a 5 O C7 <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 2 5 Ol't <br /> STOCKTON, CA 95201 cilc� VA <br /> Phone 209-465-1921 x8 <br /> Mailing Address PO BOX 2378 <br /> STOCKTON, CA 95201 <br /> Care of <br /> --acion Code 01 -STOCKTON Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax C5 - $ <br /> APN 14502004 EMal: Pr l o �lllf <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION C i <br /> Contact Name ABEL MARTIR CCS <br /> Title TERMINAL MANAGER _ r <br /> -ay Phone 209-465-1921 20 <br /> Night Phone 209-649-4999 D <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> .,ccount ID AR0016739 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner ! Facility ! Account <br /> Account Name LEHIGH SOUTHWEST CEMENT CO (Circle One) <br /> Account Balance as of 111012012: $0.00 <br /> (Circle One) <br /> Transfer to Activellnaclve <br /> ProgramlFlement and Description Record ID Employee ID and Name Status New Owner? Deiele <br /> 2220-SM HW GEN<5 TONS/YR PR0528534 EE0001421 -STACY RIVERA Active Y N A 1 0 <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIO1PRO512027 EE0000000-HAZ MAT SJC CES 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 FAC STATE SURCHAR43RO509739 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 SURCHPR0532179 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,PHS/E=HD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER an this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes andler Standards and <br /> State andlor Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! ! � <br /> Program Records to be TRANSFERED: 25.00= Amount Paid Date I / <br /> Water System to be TRANS FERED: Amount Paid Date / ! <br /> Payment Type heck Number Recety <br /> REHS: Date I Account out: Date 4_1 <br /> COMMENTS: <br /> Ileh-envlenvi sionlreports15021.rp t <br />