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I Date run 2/10/2010 9:57:40Ak SAN JO "JIN COUNTY ENVIRONMENTAL HEAL ` ` DEPARTMENT Report #5021 Run by Pagel Facility Information as of 2/10/20'1 Record Selection Criteria: Facility ID FA0005302 FACILITY FILE INFORMATION Facility ID FA0005302 Facility Name SPRECKELS SUGAR COMPANY Location 20500 HOLLY DR TRACY, CA 95304 Phone 209-835-3210 Mailing Address P8-gID)tff _Tlulwl I I 6A 953 J, 8 Care of Location Code 03 -TRACY Bos District 005 - ORNELLAS, LEROY APN EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0005764 Mail Invoices to Facility Account Name SPRECKELS SUGAR COMPANY Account Balance as of 2/10/2010: $592.00 Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN / Fed Tax ID New Owner ID 3 n Site Mitigation Facility Alt Phone Fax EMail : New Account ID: : Mail Invoices to: Owner / Facility / Account (Circle One) JILE OWNER FILE INFORMATION Owner ID OW0003473 Owner Name SPRECKELS SUGAR CO Owner DBA SPRECKELS SUGAR COMPANY Owner Address 20500 HOLLY DR Active/Inactve TRACY, CA 953041649 Home Phone Not Specified Work/Business Phone 209-835-3210 Mailing Address Pe-BgX-60 EE0005642 - MICHELLE HENRY T 8 Care of A FACILITY FILE INFORMATION Facility ID FA0005302 Facility Name SPRECKELS SUGAR COMPANY Location 20500 HOLLY DR TRACY, CA 95304 Phone 209-835-3210 Mailing Address P8-gID)tff _Tlulwl I I 6A 953 J, 8 Care of Location Code 03 -TRACY Bos District 005 - ORNELLAS, LEROY APN EMERGENCY NOTIFICATION CONTACT INFORMATION Contact Name Title Day Phone Night Phone ACCOUNTS RECEIVABLE FILE INFORMATION Account ID AR0005764 Mail Invoices to Facility Account Name SPRECKELS SUGAR COMPANY Account Balance as of 2/10/2010: $592.00 Make changes/corrections in RED ink. INFORMATION CHANGE (date) OWNERSHIP CHANGE (date) SSN / Fed Tax ID New Owner ID 3 n Site Mitigation Facility Alt Phone Fax EMail : New Account ID: : Mail Invoices to: Owner / Facility / Account (Circle One) APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: Water System to be TRANSFERED: Payment Type Check Number REHS: COMMENTS: \\eh-env\envision\reports\5021. rpt " $20.00 = $372.00 = Date Amount Paid Date Amount Paid Date Recei ed by Account out: c Date (Circle One) Transfer to Active/Inactve Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete 2220 - SM HW GEN <5 TONS/YR PR0513793 EE0005642 - MICHELLE HENRY Active Y N A I D 2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO511655 EE0000000 - HAZ MAT SJC OES Inactive Y N A I D 2244 - PACT TRANSFER RECORD - OES PR0519583 EE0000000 - HAZ MAT SJC OES Active Y N A I D 2381 - UST FACILITY (BEFORE 1/84) - obsolete PR0502021 EE0005642 - MICHELLE HENRY Inactive Y N A I D 2399 - UNIFIED PROGRAM FAC STATE SURCHAR1PR0507590 EE0000451 - STEVE SASSON Inactive Y N A I D 2840 - AST EXEMPT FAC < 1,320 GAL PR0515794 EE0005642 - MICHELLE HENRY Active,Exempt Y N A I D ERSC - ELECTRONIC REPORTING SURCHARGE PRO531511 Active Y N A I D BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project spec, PHS/EHD hourly charges associated with this facility 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 Ordinace Codes and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date Program Records to be TRANSFERED: Water System to be TRANSFERED: Payment Type Check Number REHS: COMMENTS: \\eh-env\envision\reports\5021. rpt " $20.00 = $372.00 = Date Amount Paid Date Amount Paid Date Recei ed by Account out: c Date