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Daterun 4/8/?013 4:22:15PM SAN JOt. _ iIN COUNTY ENVIRONMENTAL HEAL_ _ DEPARTMENT <br />Run b <br />Record Selection Criteria: Facility IL <br />OWNER FILE INFORMATION <br />FA0005302 <br />Facility Information as of 4/8/2013 <br />Make changes/corrections In RED ink. <br />INFORMATION CHANGE (date) <br />OWNERSHIP CHANGE (date) <br />�,N101 SSN /Fed Tax ID : <br />Owner ID OW0003473 \ �" New Owner ID <br />Owner Name SPRECKELS SUGAR CO V\ 13 <br />Owner DBA SPRECKELS SUGAR COMPANY <br />Owner Address 20500 HOLLY DR <br />TRACY, CA 953041649 <br />Home Phone Not Specified <br />Work/Business Phone 209-835-3217 <br />Mailing Address PO BOX 68 <br />MENDOTA, CA 93640 <br />Care of <br />FACILITY FILE INFORMATION Site Mitigation Facility <br />Facility ID / CERS ID FA0005302 10,181,793 <br />Facility Name SPRECKELS SUGAR COMPANY <br />Location 20500 HOLLY DR <br />TRACY, CA 95304 <br />Phone 209-835-3217 <br />Mailing Address PO BOX 68 <br />MENDOTA, CA 93640 <br />Care of <br />Location Code 99 - UNINCORPORATED P <br />Bos District 005 - ORNELLAS, LEROY y L <br />APN 21216010 <br />EMERGENCY NOTIFICATION CONTACT INFORMATION <br />Contact Name <br />Title <br />Day Phone r <br />Night Phone <br />ACCOUNTS RECEIVABLE FILE INFORMATION <br />Account ID AR0005764 <br />Mail Invoices to Facility �+ <br />Account Name SPRECKELS'SUGAR COMPANY <br />Account Balance as of 4/8/2013: $608.00 <br />Prograrn/Elemenl and Description <br />Record ID Employee ID and Name <br />Alt Phone <br />Fax <br />EMail : <br />New Account ID: : <br />Mail Invoices to: Owner / Facility / Account <br />(Circle One) <br />Report #5021 <br />Pagel <br />Status <br />(Circle One) <br />Transfer to ActiveAnactve <br />New Owner? Delete <br />1921 - HMBP-Regular-Primary Location PR0519583 <br />EE0002474 - MICHAEL PARISSI <br />Active <br />Y <br />N <br />A I ._ D <br />2220 - SM HW GEN <5 TONSNR PRO513793 <br />EE0002646 - THUY TRAN <br />Active <br />Y <br />N <br />A D <br />2224 - HAZ MAT BUSINESS PLAN AUTHORIZATIOtPR0511655 <br />EE0000000 - HAZ MAT SJC OES <br />Inactive <br />Y <br />N <br />A I D <br />2361 - UST FACILITY PR0502021 <br />EE0002646 - THUY TRAN <br />Inactive <br />Y <br />N <br />A I D <br />2399 - UNIFIED PROGRAM FAC STATE SURCHAR(PR0507590 <br />EE0000451 - STEVE SASSON <br />Inactive <br />Y <br />N <br />A I D <br />2840 - AST EXEMPT FAC < 1,320 GAL PR0515794 <br />EE0002646 - THUY TRAN <br />Active,Exempt <br />Y <br />N <br />A I D <br />ERSC - ELECTRONIC REPORTING STATE SURCH,PR0531511 <br />Inactive <br />Y <br />N <br />A I D <br />BILLING and COMPLIANCE ACKNOWLEDGEMENT:I, the undersigned owner, operator or agent of same, acknowledge that all site, and/or project <br />specific, PHS/EHD hourly <br />charges associated <br />with (his facility <br />or activity will be billed to the party identified as the OWNER on this form I also certify that <br />all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards <br />and State and'or <br />Federal Laws. <br />APPLICANT'S SIGNATURE: / �-- Date ! / <br />Program Records to be TRANSFERED: ` $25.00 = Amount Paid Date ! I <br />Water System to be TRANSFERED: Amount Paidto <br />Payment Type Check Number Recei dbV <br />RENS: Ci 5 -71Z.2 -t.. Date ! / Account out: Date <br />COMMENTTSSSS: ? <- - !� L-4 �/� /� <br />/ /, J IL <br />